Co-manipulation surgical system having multiple operational modes for use with surgical instruments for performing laparoscopic surgery

ABSTRACT

Co-manipulation robotic systems are described herein that may be used for assisting with laparoscopic surgical procedures. The co-manipulation robotic systems allow a surgeon to use commercially-available surgical tools while providing benefits associated with surgical robotics. Advantageously, the surgical tools may be seamlessly coupled to the robot arms using a disposable coupler while the reusable portions of the robot arm remain in a sterile drape. Further, the co-manipulation robotic system may operate in multiple modes to enhance usability and safety, while allowing the surgeon to position the instrument directly with the instrument handle and further maintain the desired position of the instrument using the robot arm.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation application of PCT Patent Appl. No.PCT/IB2022/052989, filed Mar. 30, 2022, which claims priority to EPPatent Appl. No. 21306904.0, filed Dec. 22, 2021, EP Patent Appl. No.21306905.7, filed Dec. 22, 2021, EP Patent Appl. No. 21305929.8, filedJul. 5, 2021, and EP Patent Appl. No. 21305417.4, filed Mar. 31, 2021,the entire contents of each of which are incorporated herein byreference.

FIELD OF USE

The present disclosure is directed to co-manipulation robotic systemsfor assisting with laparoscopic surgical procedures.

BACKGROUND

Managing vision and access during a laparoscopic procedure is achallenge. The surgical assistant paradigm is inherently imperfect, asthe assistant is being asked to anticipate and see with the surgeon'seyes, without standing where the surgeon stands, and similarly toanticipate and adjust how the surgeon wants the tissue of interestexposed, throughout the procedure. For example, during a laparoscopicprocedure, one assistant may be required to hold a retractor device toexpose tissue for the surgeon, while another assistant may be requiredto hold a laparoscope device to provide a field of view of the surgicalspace within the patient to the surgeon during the procedure, either oneof which may be required to hold the respective tools in an impracticalposition, e.g., from between the arms of the surgeon while the surgeonis actively operating additional surgical instruments.

Various attempts have been made at solving this issue. For example, arail-mounted orthopedic retractor, which is a purely mechanical devicethat is mounted to the patient bed/table, may be used to hold alaparoscope device in position during a laparoscopic procedure, andanother rail-mounted orthopedic retractor may be used to hold aretractor device in position during the laparoscopic procedure. However,the rail-mounted orthopedic retractor requires extensive manualinteraction to unlock, reposition, and lock the tool in position.

Complex robot-assisted systems such as the Da Vinci Surgical System(made available by Intuitive Surgical, Sunnyvale, Calif.) have been usedby surgeons to enhance laparoscopic surgical procedures by permittingthe surgeon to tele-operatively perform the procedure from a surgeonconsole remote from the patient console holding the surgicalinstruments. Such complex robot-assisted systems are very expensive, andhave a very large footprint and take up a lot of space in the operatingroom. Moreover, such robot-assisted systems typically require uniquesystem-specific surgical instruments that are compatible with thesystem, and thus surgeons may not use standard off-the-shelf surgicalinstruments that they are used to. As such, the surgeon is required tolearn an entirely different way of performing the laparoscopicprocedure.

In view of the foregoing drawbacks of previously known systems andmethods, there exists a need for a system that provides the surgeon withthe ability to seamlessly position and manipulate various surgicalinstruments as needed, thus avoiding the workflow limitations inherentto both human and mechanical solutions.

SUMMARY

The present disclosure overcomes the drawbacks of previously-knownsystems and methods by providing a co-manipulation surgical system toassist with laparoscopic surgery performed using a surgical instrumenthaving a handle, an operating end, and an elongated shaft therebetween.The co-manipulation surgical system may include a robot arm having aproximal end, a distal end that may be removably coupled to the surgicalinstrument, a plurality of links, and a plurality of joints between theproximal end and the distal end. The co-manipulation surgical systemfurther may include a controller operatively coupled the robot arm. Thecontroller may be programmed to cause the robot arm to automaticallyswitch between: a passive mode responsive to determining that movementof the robot arm due to movement at the handle of the surgicalinstrument is less than a predetermined amount for at least apredetermined dwell time period, wherein the controller may beprogrammed to cause the robot arm to maintain a static position in thepassive mode; and a co-manipulation mode responsive to determining thatforce applied at the robot arm due to force applied at the handle of thesurgical instrument exceeds a predetermined threshold, wherein thecontroller may be programmed to permit the robot arm to be freelymoveable in the co-manipulation mode responsive to movement at thehandle of the surgical instrument for performing laparoscopic surgeryusing the surgical instrument, and wherein the controller may beprogrammed to apply a first impedance to the robot arm in theco-manipulation mode to account for weight of the surgical instrumentand the robot arm. The controller further may be programmed to cause therobot arm to automatically switch to a haptic mode responsive todetermining that at least a portion of the robot arm is outside apredefined haptic barrier, wherein the controller may be programmed toapply a second impedance to the robot arm in the haptic mode greaterthan the first impedance, thereby making movement of the robot armresponsive to movement at the handle of the surgical instrument moreviscous in the haptic mode than in the co-manipulation mode

In addition, the co-manipulation surgical system may include a baserotatably coupled to the proximal end of the robot arm, such that therobot arm may move relative to the base. For example, the base may berotatable about a first axis, such that rotation of the base causesrotation of the robot arm about the first axis. Accordingly, the systemfurther may include a first motor disposed within the base andoperatively coupled to the base, such that the controller is operativelycoupled to the first motor and programmed to cause the first motor toapply impedance to the base. Moreover, a proximal end of a shoulder linkof the plurality of links may be rotatably coupled to the base at ashoulder joint of the plurality of joints, such that rotation of theshoulder link causes rotation of links of the plurality of links distalto the shoulder link about a second axis of the shoulder joint.Accordingly, the system further may include a second motor disposedwithin the base and operatively coupled to the shoulder joint, such thatthe controller is operatively coupled to the second motor and programmedto cause the second motor to apply impedance to the shoulder joint. Forexample, the second axis may be perpendicular to the first axis.

Further, a proximal end of an elbow link of the plurality of links mayrotatably coupled to a distal end of the shoulder link at an elbow jointof the plurality of joints, such that rotation of the elbow link causesrotation of links of the plurality of links distal to the elbow linkabout a third axis of the elbow joint. Accordingly, the system furthermay include a third motor disposed within the base and operativelycoupled to the elbow joint, such that the controller is operativelycoupled to the third motor and programmed to cause the third motor toapply impedance to the elbow joint. The shoulder link may include aproximal shoulder link rotatably coupled to the base and a distalshoulder link rotatably coupled to the elbow link. The distal shoulderlink may be rotatable relative to the proximal shoulder link, such thatrotation of the distal shoulder link relative to the proximal shoulderlink causes rotation of links of the plurality of links distal to thedistal shoulder link to rotate about a fourth axis parallel to alongitudinal axis of the shoulder link.

The system further may include an actuator that may be actuated topermit rotation of the distal shoulder link relative to the proximalshoulder link, wherein, in an unactuated state, the actuator preventsrotation of the distal shoulder link relative to the proximal shoulderlink. In addition, a proximal end of a wrist link of the plurality oflinks may be rotatably coupled to a distal end of the elbow link at aproximal wrist joint of the plurality of joints, such that the wristlink may be rotated relative to the elbow link about a fifth axis of theproximal wrist joint. The system further may include an actuator thatmay be actuated to permit rotation of the wrist link relative to theelbow link, wherein, in an unactuated state, the actuator preventsrotation of the wrist link relative to the elbow link. The wrist linkmay include a proximal wrist link rotatably coupled to the distal end ofthe elbow link, a middle wrist link rotatably coupled to proximal wristlink about a sixth axis, and a distal wrist link rotatably coupled tothe middle wrist link about a seventh axis. The distal wrist link may beremovably coupled to the surgical instrument.

The system further may include a platform coupled to the base. Theplatform may permit vertical and horizontal movement of the baserelative to the platform, to thereby cause vertical and horizontalmovement of the robot arm relative to the platform. The platform mayinclude a plurality of wheels that may permit mobility of the platform,the plurality wheels having a brake mechanism that may be actuated toprevent mobility of the platform. Moreover, the controller may beprogrammed to receive information associated with the surgicalinstrument coupled to the distal end of the robot arm, the informationincluding at least one of instrument type, weight, center of mass,length, or instrument shaft diameter.

The system further may include a database having information associatedwith a plurality of surgical instruments, wherein the controller isprogrammed to access the database to retrieve the information associatedwith the surgical instrument coupled to the distal end of the robot arm.In addition, the system may include an optical scanner that may measuredepth data, such that the controller is programmed to identify thesurgical instrument coupled to the distal end of the robot arm based onthe measured depth data. Moreover, the controller may be programmed tobe calibrated to the surgical instrument when the surgical instrument iscoupled to the distal end of the robot arm.

The system further may include a base housing at the proximal end of therobot arm, and motors for controlling the robot arm, such that all themotors for the robot arm are disposed within the base housing. Forexample, the system further may include a base rotatably coupled to theproximal end of the robot arm, such that the robot arm may move relativeto the base, and a plurality of motors disposed within the base that areoperatively coupled to at least some joints of the plurality of joints,such that wherein the controller is operatively coupled to the pluralityof motors and programmed to measure current of the plurality of motors.

The controller further may be programmed to calculate a force applied tothe distal end of the robot arm based on the measured current of theplurality of motors. Moreover, the controller may be programmed todetermine a point of entry of the surgical instrument into a patient inreal-time based on a longitudinal axis of the surgical instrument whenthe surgical instrument is coupled to the distal end of the robot arm.For example, the controller may be programmed to determine the point ofentry of the surgical instrument into the patient in real-time bydetermining a point of intersection of a plurality of virtual linesparallel to the longitudinal axis of the surgical instrument as thesurgical instrument moves relative to the point of entry. In addition,the controller may be programmed to calculate a force applied to theoperating end of the surgical instrument based on the force applied tothe distal end of the robot arm, the length of the surgical instrument,the center of mass of the surgical instrument, and the point of entry.Additionally, the controller may be programmed to calculate a forceapplied to the patient at the point of entry of the surgical instrumentinto the patient based on the force applied to the distal end of therobot arm, the center of mass of the surgical instrument, and the pointof entry. The controller further may be programmed to detect a faultcondition of the co-manipulation surgical system, and wherein, if amajor fault condition is detected, the controller may cause actuation ofbrakes of the plurality of motors. Moreover, the controller may beprogrammed to apply a third impedance to the robot arm to resistmovement of the robot arm if the force applied to the distal end of therobot arm exceeds a predetermined force threshold within a predeterminedtime period.

The system further may include a plurality of encoders disposed on atleast some joints of the plurality of joints, wherein the plurality ofencoders may measure angulation of corresponding links of the pluralityof links at the at least some joints, such that the controller may beprogrammed to determine a position of the distal end of the robot arm in3D space based on the angulation measurements by the plurality ofencoders. In addition, the system may include one or more indicatorsdisposed on at least one link of the plurality of links of the robotarm, wherein the one or more indictors may illuminate a plurality ofcolors, each color indicative of a state of the co-manipulation surgicalsystem. For example, a first color of the plurality of colors mayindicate that the robot arm is in the passive mode, a second color ofthe plurality of colors may indicate that the robot arm is in theco-manipulation mode, and a third color of the plurality of colors mayindicate that the robot arm is in the haptic mode. Moreover, a fourthcolor of the plurality of colors may indicate a fault condition of theco-manipulation surgical system is detected by the controller.Additionally, a fifth color of the plurality of colors may indicate thatno surgical instrument is coupled to the distal end of the robot arm.

The predefined haptic barrier may be used to guide the surgicalinstrument coupled to the distal end of the robot arm to assist with thelaparoscopic surgery. For example, the predefined haptic barrier may bea haptic funnel that may guide the surgical instrument coupled to thedistal end of the robot arm into a trocar. The controller may beprogrammed to apply a third impedance to the robot arm to account forweight of the robot arm when no surgical instrument is coupled to thedistal end of the robot arm. Moreover, in the passive mode, thecontroller may be programmed to apply a third impedance to the robot armto account for weight of the surgical instrument, the weight of therobot arm, and a force applied to the distal end of the robot arm due toan external form applied to the surgical instrument to cause the robotarm to maintain the static position.

The system further may include a graphical user interface that maydisplay information associated with the surgical instrument coupled tothe distal end of the robot arm. The graphical user interface may permita user to adjust at least one of: the predetermined amount of movementat the handle of the surgical instrument or the predetermined dwell timeperiod to cause the robot arm to automatically switch to the passivemode, the predetermined threshold of force applied at the handle of thesurgical instrument to cause the robot arm to automatically switch tothe co-manipulation mode, a position of the predefined haptic barrier,an identity of the surgical instrument coupled to the distal end of therobot arm, a vertical height of the robot arm, or a horizontal positionof the robot arm.

The system further may include a coupler body that may be removablycoupled to a coupler interface disposed at the distal end of the robotarm. The coupler body may have a lumen sized and shaped to receive theelongated shaft of the surgical instrument therethrough, may transitionbetween an open state where the elongated shaft is slidably moveablewithin the lumen, and a closed state where longitudinal movement of theelongated shaft relative to the coupler body is inhibited whilerotational movement of the elongated shaft relative to the coupler bodyis permitted responsive to movement at the handle of the surgicalinstrument. For example, when the coupler body is coupled to the couplerinterface in the closed state, the robot arm may be permitted to befreely moveable responsive to movement at the handle of the surgicalinstrument for performing laparoscopic surgery if the force applied atthe robot arm due to force applied at the handle of the surgicalinstrument exceeds the predetermined threshold. In the closed state,longitudinal movement of the elongated shaft relative to the couplerbody may be inhibited while rotational movement of the elongated shaftrelative to the coupler body is permitted responsive to movement at thehandle of the surgical instrument due to frictional forces between thelumen of the coupler body and the elongated shaft of the surgicalinstrument.

In addition, the coupler body may be removably coupled to the couplerinterface via a magnetic connection. The controller may be programmed todetermine an orientation of the surgical instrument relative to thedistal end of the robot arm when the coupler body is coupled to thecoupler interface based on an alignment of the magnetic connection. Thesystem further may include a sterile drape that may be disposed betweenthe coupler body and the coupler interface, such that the sterile drapeprevents contact between the surgical instrument and the robot armduring the laparoscopic surgery. The distal end of the robot arm may beremovably coupled to at least one of a laparoscope, a retractor tool, agrasper tool, or a surgical cutting tool. For example, when the distalend of the robot arm is coupled to a laparoscope, the controller may beprogrammed to optically track an end-effector of one or more surgicalinstruments within a field of view of the laparoscope, and to cause therobot arm to automatically switch to a robotic assist mode responsive todetermining that the end-effector of the one or more surgicalinstruments are not within a predefined boundary within the field ofview of the laparoscope. Moreover, the controller may be programmed tocause the robot arm to move the laparoscope to adjust the field of viewof the laparoscope such that the end-effector of the one or moresurgical instruments are within the predefined boundary within the fieldof view of the laparoscope.

The co-manipulation surgical system may not be teleoperated via userinput received at a remote surgeon console. In addition, theco-manipulation surgical system may be structured such that a surgeonperforming the laparoscopic surgery does not contact any portion of theco-manipulation surgical system to move the surgical instrument whileperforming the laparoscopic surgery. Moreover, the system may include anoptical scanner, e.g., a LiDAR device, for measuring depth data. Forexample, the controller may be programmed to determine whether amovement applied to the surgical instrument coupled to the distal end ofthe robot arm is by an intended user. Additionally, the controller maybe programmed to identify the surgical instrument coupled to the distalend of the robot arm based on the depth data.

In addition, the system may include a second robot arm having a proximalend, a distal end that may be removably coupled to a second surgicalinstrument having a handle, an operating end, and an elongated shafttherebetween, a plurality of links, and a plurality of joints betweenthe proximal end and the distal end. Accordingly, the controller may beoperatively coupled the second robot arm, and programmed to cause thesecond robot arm to automatically switch between: the passive moderesponsive to determining that movement of the second robot arm due tomovement at the handle of the second surgical instrument is less than apredetermined amount for at least a predetermined dwell time periodassociated with the second robot arm, wherein the controller may beprogrammed to cause the second robot arm to maintain a static positionin the passive mode; the co-manipulation mode responsive to determiningthat force applied at the second robot arm due to force applied at thehandle of the second surgical instrument exceeds a predeterminedthreshold associated with the second robot arm, wherein the controllermay be programmed to permit the second robot arm to be freely moveablein the co-manipulation mode responsive to movement at the handle of thesecond surgical instrument for performing laparoscopic surgery using thesecond surgical instrument, and wherein the controller may be programmedto apply a third impedance to the second robot arm in theco-manipulation mode to account for weight of the second surgicalinstrument and the robot arm; and optionally the haptic mode responsiveto determining that at least a portion of the second robot arm isoutside the predefined haptic barrier, the controller may be programmedto apply a fourth impedance to the second robot arm in the haptic modegreater than the third impedance, thereby making movement of the secondrobot arm responsive to movement at the handle of the second surgicalinstrument more viscous in the haptic mode than in the co-manipulationmode.

In accordance with another aspect of the present disclosure, aco-manipulation robotic surgical device for manipulating an instrumentis provided. The device may include a base portion, a first arm coupledwith the base portion, a motor coupled with the first arm that mayrotate the first arm relative to the base portion, an instrument coupledwith an end portion of the first arm, and a controller that may beprogrammed to control the first arm according to at least two of thefollowing operational modes: passive assistant mode; co-manipulationassistant mode; robotic assistant mode; and haptic mode. For example, inthe passive assistant mode, the first arm is static. In theco-manipulation assistant mode, the first arm may be freely movable byan operator while the motor at least partially simultaneously moves thefirst arm to improve a position and/or orientation of the instrumentcoupled with the end portion of the first arm and/or to compensate atleast for a force of gravity on the first arm and the instrument that iscoupled with the end portion of the first arm. In the robotic assistantmode, the motor may move the first arm to reposition the instrumentcoupled with the end portion of the first arm. In the haptic mode, thefirst arm may be movable by an operator while the motor compensates atleast for a force of gravity on the first arm and/or the instrument thatis coupled with the end portion of the first arm and at least guides theinstrument along a predefined trajectory, prevents unwanted movements ofthe first arm and/or the instrument coupled with the end portion of thefirst arm, prevents a movement of the first arm outside of a particularspace, and/or prevents a movement of the first arm into a particularspace.

In one embodiment, the controller may be switchable between any one ofat least three of the operational modes. Alternatively, the controllermay be switchable between any one of the four operational modes. Theco-manipulation robotic surgical device may be programmed toautomatically identify the particular instrument that is coupled withthe end portion of the first arm using an RFID transmitter chip, abarcode, a near field communication device, a Bluetooth transmitter,and/or a weight of the instrument that is coupled with the end portionof the first arm. Moreover, the co-manipulation robotic surgical devicemay be programmed to automatically change to a predetermined one of theoperational modes when a particular instrument is coupled with the endportion of the first arm without any additional input from an operator.For example, the co-manipulation robotic surgical device may beprogrammed to change to the passive assistant mode when a particularinstrument is coupled with the end portion of the first arm without anyadditional input from an operator.

In accordance with another aspect of the present invention, anotherco-manipulation surgical system to assist with laparoscopic surgeryperformed using a surgical instrument having a handle, an operating end,and an elongated shaft therebetween is provided. The co-manipulationsurgical system may include a robot arm having a proximal end, a distalend that may be removably coupled to the surgical instrument, aplurality of links, and a plurality of joints between the proximal endand the distal end. The distal end of the robot arm may include acoupler interface. The system further may include a coupler body thatmay be removably coupled to the coupler interface. The coupler body mayinclude a lumen sized and shaped to receive the elongated shaft of thesurgical instrument therethrough, and may to transition between an openstate where the elongated shaft is slidably moveable within the lumen,and a closed state where longitudinal movement of the elongated shaftrelative to the coupler body is inhibited while rotational movement ofthe elongated shaft relative to the coupler body is permitted responsiveto movement at the handle of the surgical instrument. For example, whenthe coupler body is coupled to the coupler interface in the closedstate, the robot arm is permitted to be freely moveable responsive tomovement at the handle of the surgical instrument for performinglaparoscopic surgery.

The coupler body may be removably coupled to the coupler interface via amagnetic connection. Accordingly, the controller may be programmed todetermine an orientation of the surgical instrument relative to thedistal end of the robot arm when the coupler body is coupled to thecoupler interface based on an alignment of the magnetic connection. Thesystem further may include a sterile drape that may be disposed betweenthe coupler body and the coupler interface, such that the sterile drapeprevents contact between the surgical instrument and the robot armduring the laparoscopic surgery. The coupler body may be disposableafter a single laparoscopic surgery.

In accordance with another aspect of the present invention, a device forcoupling an instrument, e.g., a laparoscopic surgical instrument or anendoscope, to an arm of a surgical robot is provided. The device mayinclude a body sized and shaped to selectively couple with an instrumentfor use in a surgical operation, and an interface that may selectivelycouple with the body and may be coupled with an end portion of a roboticarm. For example, the device may permit the instrument to rotate about alongitudinal axis of the instrument relative to the device, and furthermay inhibit longitudinal movement of the instrument relative to thedevice. The body may clamp around a portion of an outside surface of theinstrument. For example, the body may include a first portion coupledwith a second portion with a hinge, wherein the first portion may rotateabout the hinge relative to the second portion so as to selectivelyclamp the instrument in a recess formed in the body.

In addition, the body may clamp around a portion of an outside surfaceof the instrument and prevent a rotational movement of the instrumentrelative to the body under normal operating conditions. For example, theinterface may include a recess sized and shaped to removably receive thebody therein. The recess of the interface may inhibit longitudinalmovement of the body relative to the interface and permit rotationalmovement of the body relative to the interface. Moreover, the device maymove between a first state in which the instrument is removable from thedevice and a second state in which the instrument is nonremovable fromthe device. The body may have one or more projections extending awayfrom a surface of the body and the interface may have one or moredepressions for receiving the one or more projections to align the bodywith the interface.

In accordance with yet another aspect of the present invention, aco-manipulation surgical robot system for performing a surgicalprocedure is provided. The system may include a first surgical robothaving a base, an arm coupled with the base, and a motor coupled withthe arm and that may move the arm relative to the base, as well as acontroller programmed to control the arm, and an optical scanner thatmay collect depth data. For example, the optical scanner may collectdepth data related to a position and an orientation of an instrumentwith respect to the co-manipulation surgical robot. The system may beprogrammed to use the depth data to determine if the instrument iscoupled with the first surgical robot. Moreover, the system may beprogrammed to determine an identity of the instrument based at least inpart on the depth data.

The optical scanner may collect depth data related to a position and amovement of an instrument, wherein the instrument may be freely held bya surgeon and not coupled with a surgical robot. Moreover, the opticalscanner may collect depth data related to a trocar inserted into thepatient. Accordingly, the system may be programmed to move the armand/or the base of the first surgical robot if the position of thetrocar changes more than a threshold amount. The system further mayinclude a second surgical robot having a second base, a second armcoupled with the second base, a second motor coupled with the second armand that may move the second arm relative to the second base. Theoptical scanner may have an accuracy of at least 5 mm at a range of 10meters. The optical scanner further may collect depth data related to asurgeon's hand during a surgical procedure.

Moreover, the controller may be programmed to control the arm of thefirst surgical robot according to at least one of the followingoperational modes: passive assistant mode; co-manipulation assistantmode; robotic assistant mode; and haptic mode, as described above. Theoptical scanner may use the depth data to identify a potentialinadvertent collision between the arm of the first surgical robot and apatient, a support platform supporting at least the first surgicalrobot, another surgical robot, and/or another object in an operatingroom and to warn a user of the potential inadvertent collision and/orinhibit a movement of the arm of the first surgical robot to avoid sucha collision. In addition, the first surgical robot may be supported by asupport platform and wherein the co-manipulation surgical robot systemmay be programmed to move the first surgical robot relative to thesupport platform based on the depth data collected by the opticalscanner to optimize a position of the first surgical robot on thesupport platform. In addition, the optical scanner may collect depthdata used to record a movement of a surgeon's hand during a surgicalprocedure.

In accordance with another aspect of the present invention, anotherco-manipulation surgical robot system for performing a surgicalprocedure is provided. The system may include a surgical robot having abase, an arm coupled with the base, and a motor coupled with the arm, aswell as an optical scanner that may track a movement of one or moreobjects around a patient, and a controller programmed to collect datafrom the optical sensor regarding the movement of one or more objectsand to move the arm of the surgical robot in response to the movement ofone or more objects.

In accordance with another aspect of the present invention, aco-manipulation robotic surgical system for assisting in themanipulation of an instrument is provided. The system may include abase, an arm coupled with the base, the arm having a plurality of armsegments and a plurality of articulation joints, a plurality of motorscoupled with the arm, wherein the plurality of motors may rotate theplurality of arm segments about the plurality of articulation joints,and a controller programmed to control at least the plurality of motors.For example, the arm may be movable by a user exerting a force directlyon the arm and/or directly on an instrument coupled with the arm.Moreover, the system may be programmed to collect data related to afirst operating characteristic of the arm and/or an instrument coupledwith the arm. Additionally, the controller may be programmed to analyzethe data related to the first operating characteristic to detect whethera first condition exists, and to modify a first operating parameter ofthe arm if the first condition is detected.

The system may be programmed to compare the data collected during asurgical procedure with historical data related to the same surgicalprocedure for a same user using the instrument to detect if the firstcondition exists. The system further may include an optical scanner, oneor more sensors positioned on the arm, and/or an endoscope to collectdata related to the first operating characteristic of the arm and/or aninstrument coupled with the arm. The controller may be programmed toautomatically change a position and/or an orientation of an imagingdevice supported by the arm to a preferred or optimal position and/ororientation if a position and/or an orientation of the imaging device isnot the preferred or the optimal position of the camera for capturing animage of the instrument. In addition, the controller may be programmedto detect if an instrument coupled with the arm is replaced.

In addition, the system may be programmed to detect a magnitude andduration of one or more forces applied to the first robotic arm, andfurther to detect that the first condition exists if a change in a forceapplied to the arm meets or exceeds a first predetermined value over athreshold duration of time. The system further may be programmed tocalculate an actual direction or an actual approximate direction that anend effector at a distal end of the arm is pointing to and a calculateddirection or a calculated approximate direction that the end effectorwould be pointing to if an instrument were coupled with the end effectorand to compare the actual direction or the actual approximate directionwith the calculated direction or the calculated approximate directionand determine if the actual direction or the actual approximatedirection and the calculated direction or the calculated approximatedirection are different. The controller may be programmed such that, ifa first instrument coupled with the arm is replaced by a secondinstrument, the controller updates a data file associated with thesecond instrument, wherein the data file associated with the secondinstrument includes at least a center of gravity of the secondinstrument and viscosity parameter of the second instrument.

In addition, the controller may be programmed to detect if a magnitudeof force exerted at a distal end of an instrument coupled with the armequals or exceeds a first value and/or if a magnitude of a force exertedon a trocar through which the instrument passes equals or exceeds asecond value and to provide an alert to a user of the arm if themagnitude of force exerted at the distal end of the instrument coupledwith the arm equals or exceeds the first value and/or if the magnitudeof the force exerted on the trocar through which the instrument passesequals or exceeds the second value. Moreover, the controller may beprogrammed to detect if a dwell time of the arm and/or an instrumentcoupled with the arm equals or exceeds a threshold dwell time, andfurther to change an operational state of the arm to a static hold stateif the dwell time of the arm and/or an instrument coupled with the armequals or exceeds the threshold dwell time, wherein the dwell time is anamount of time that the arm and/or an instrument coupled with the arm isheld in a static position.

In the static hold state, the system may be programmed to hold the armin a static position and to inhibit a movement of the arm from thestatic position of the arm except when a force applied to the arm and/oran instrument held by the arm by a user of the system equals or exceedsa predefined threshold release force value. The arm and/or an instrumentcoupled with the arm may be considered to be held in a static positionwhen the arm is not moved more than 5 mm in any direction during thedwell time. In some embodiments, the threshold dwell time may be lessthan one-half of a second. In addition, the controller may be programmedto detect whether a user is attempting to remove a first instrument fromthe arm, such that the controller may be programmed to reduce a couplingforce applied by the arm to the first instrument if the controllerdetects that the user is attempting to remove the first instrument fromthe arm.

The system further may include a support platform for supporting atleast the base. Accordingly, the controller may be programmed to detectwhether a surgical procedure is being initiated, and to move the supportplatform supporting the base to an initial position and/or the arm to aninitial position and/or orientation for the particular surgicalprocedure before the surgical procedure has started if the controllerdetects that a surgical procedure is being initiated.

In accordance with yet another aspect of the present invention, anotherco-manipulation robotic surgical system for assisting in themanipulation of an instrument is provided. The system may include

a base, an arm coupled with the base, the arm having a plurality of armsegments and a plurality of articulation joints, a plurality of motorscoupled with the arm, wherein the plurality of motors may rotate theplurality of arm segments about the plurality of articulation joints,and a controller programmed to control at least the plurality of motors.For example, the arm may be movable by a user exerting a force directlyon the arm and/or directly on an instrument coupled with the arm. Uponan identification of a first user, the system may be programmed toautomatically load a data file associated with the first user comprisingat least a first operating parameter configured to modify an operatingcharacteristic of the co-manipulation robotic surgical system.Accordingly, the controller may be programmed to control the pluralityof motors according to at least the first operating parameter.

The first operating parameter of the data file associated with the firstsurgeon may be based at least in part on data collected during priorsurgical procedures performed by the first user. Additionally, the firstoperating parameter of the data file associated with the first user maybe based at least in part on manually entered preferences for the firstuser. The system may be programmed to automatically identify the firstuser using an optical scanner. In addition, the co-system may beprogrammed to automatically load the data file associated with the firstuser upon manual input of an identity of the first user. The data fileassociated with the first user may include a threshold dwell time valuebased on dwell time data collected from procedures performed by thefirst user and/or preferences manually input for the first user.Moreover, the data file associated with the first user may include adwell speed value based on data collected from procedures performed bythe first user and/or preferences manually input for the first user.

In addition, the data file associated with the first user may include alaparoscopic view parameter based on laparoscopic view data collectedfrom procedures performed by the first user, such that the controllermay be programmed to automatically change a position and/or anorientation of a laparoscope according to the laparoscopic view datacollected from procedures performed by the first user. The data fileassociated with the first user may include a setup joint parameter basedon setup joint position data collected from past procedures performed bythe first user. In addition, the data file may include instrumentcalibration parameters based on instrument calibration values input bythe first user. The first operating parameter may be based on at leastone of a pose of the first user, a height of the first user, or a handpreference of the first user.

Moreover, the controller may be programmed to automatically detect whenthe instrument coupled with the arm is not in an optimal or preferredlocation based on data collected from procedures performed by the firstuser and to move the arm so that the instrument is in the optimal orpreferred location. In addition, the system may be programmed to detectwhen the first user desires to change an operating mode of the system toa static hold mode even when a dwell time of the arm and/or aninstrument coupled with the arm is less than a threshold dwell time. Thedata file may be communicable from a network database in communicationwith the co-manipulation surgical robot system. Additionally, the firstoperating parameter of the data file associated with the first user maybe based at least in part on data collected during prior surgicalprocedures performed by a plurality of users.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B illustrate a traditional laparoscopic procedureperformed by a surgeon and one or more assistants.

FIG. 2 illustrates an exemplary co-manipulation surgical systemconstructed in accordance with the principles of the present disclosure.

FIGS. 3A-3D illustrate an exemplary robot arm of the system of FIG. 2constructed in accordance with the principles of the present disclosure.

FIGS. 4A and 4B illustrate an exemplary wrist portion of the robot armof FIGS. 3A-3D constructed in accordance with the principles of thepresent disclosure.

FIG. 4C is a close-up view of an exemplary surgical instrument couplingmechanism of the wrist portion of FIGS. 4A and 4B.

FIG. 4D is a close-up view of an exemplary robot arm coupler interfaceof the surgical instrument coupling mechanism of FIG. 4C constructed inaccordance with the principles of the present disclosure.

FIGS. 5A and 5B illustrate an exemplary surgical instrument coupler bodyof the surgical instrument coupling mechanism of FIG. 4C constructed inaccordance with the principles of the present disclosure.

FIG. 6A illustrates an alternative exemplary surgical instrument couplerbody constructed in accordance with the principles of the presentdisclosure.

FIGS. 6B-6D illustrate attachment of the coupler body of FIG. 6A to asurgical retractor device in accordance with the principles of thepresent disclosure.

FIG. 7A illustrates another alternative exemplary surgical instrumentcoupler body constructed in accordance with the principles of thepresent disclosure.

FIGS. 7B-7D illustrate attachment of the coupler body of FIG. 7A to asurgical laparoscope device in accordance with the principles of thepresent disclosure.

FIGS. 8A and 8B illustrate the robot arms in a sterile-drape readyconfiguration.

FIGS. 9A and 9B illustrate the robot arms covered in a sterile drape.

FIGS. 10A-10D illustrate rotation of the shoulder link of the robot armin accordance with the principles of the present disclosure.

FIG. 11A illustrates an exemplary co-manipulation surgical system havingan optical scanner in accordance with the principles of the presentdisclosure, and FIG. 11B illustrates the optical scanner of FIG. 11A.

FIG. 12 illustrates a user operating the co-manipulation surgical systemof FIG. 11A in accordance with the principles of the present disclosure.

FIG. 13A illustrates a field of view of the optical scanner during alaparoscopic surgical procedure, and FIG. 13B illustrates a depth map ofthe field of view the optical scanner of FIG. 13A.

FIG. 14 shows some example components that may be included in aco-manipulation robot platform in accordance with the principles of thepresent disclosure.

FIG. 15 is a flow chart illustrating operation of the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 16 is a flow chart illustrating surgical instrument calibration ofthe co-manipulation surgical system in accordance with the principles ofthe present disclosure.

FIG. 17 is a flow chart illustrating operation of the robot arm inaccordance with the principles of the present disclosure.

FIGS. 18A and 18B are free-body diagrams illustrating forces applied tothe surgical instrument coupled to the robot arm during a laparoscopicsurgical procedure.

FIG. 19 is a table of example values related to some arrangements of apassive mode of the robot arm in accordance with the principles of thepresent disclosure.

FIG. 20 illustrates an example overview of some features andcapabilities of the co-manipulation surgical system in accordance withthe principles of the present disclosure.

FIG. 21 is a schematic overview of some electrical components andconnectivity of the co-manipulation surgical system in accordance withthe principles of the present disclosure.

FIG. 22 is a flow chart illustrating an example process of acquisitionand processing of data from an optical scanner and an exampleapplication of the data in accordance with the principles of the presentdisclosure.

FIG. 23 is a schematic overview of data flow of the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 24 is another schematic overview of data flow the co-manipulationsurgical system in accordance with the principles of the presentdisclosure.

FIG. 25 is a schematic overview of data flow and output control of theco-manipulation surgical system in accordance with the principles of thepresent disclosure.

FIG. 26 is a schematic overview of data flow in a network ofco-manipulation surgical systems in accordance with the principles ofthe present disclosure.

FIGS. 27A-27D illustrate vertical and horizontal movement of the robotarms in accordance with the principles of the present disclosure.

FIGS. 28A-28D illustrate an exemplary graphical user interface of theco-manipulation surgical system.

FIG. 29 is a schematic of an alternative co-manipulation surgical systemconstructed in accordance with the principles of the present disclosure.

FIGS. 30A-43 illustrate various alternative surgical instrument couplingmechanisms constructed in accordance with the principles of the presentdisclosure.

DETAILED DESCRIPTION

Disclosed herein are co-manipulation surgical robot systems forassisting an operator, e.g., a surgeon, in performing a surgicalprocedure, e.g., a laparoscopic procedure, and methods of use thereof.Currently, laparoscopic procedures typically require a surgeon and oneor more assistants. For example, as shown in FIG. 1A, during alaparoscopic procedure assistant A1 may be required to hold retractordevice 12 to expose tissue for surgeon S, while another assistant A2 maybe required to hold laparoscope device 10 to provide a field of view ofthe surgical space within the patient to surgeon S via a display (notshown) during the procedure. As shown in FIG. 1A, assistant A2 may berequired to hold laparoscope device 10 in an impractical position, e.g.,from between the arms of surgeon S while the surgeon actively operatesadditional surgical instruments, e.g., surgical instruments 14 and 16.As further shown in FIG. 1A, surgeon S may need to let go of surgicalinstrument 16 in order to guide/reposition laparoscope device 10 held byassistant A2 in order to achieve the field of view desired by thesurgeon.

As shown in FIG. 1B, rail-mounted orthopedic retractors 18 may be usedto hold one or more surgical instruments in position during thelaparoscopic procedure, in attempt to free hands of the surgeon and/orassistant for other tasks, as well as for stability. As shown in FIG.1B, first rail-mounted orthopedic retractor 18 a may include retractorend 20 a for engaging with and holding laparoscope device 10 in positionupon actuation of lock 22 a. For example, lock 22 a may be disengagedsuch that retractor 18 a may be manually positioned at a desiredlocation relative to the patient, and re-engaged to lock retractor 18 a,and accordingly laparoscopic device 10 coupled thereto, in the desiredposition. As shown in FIG. 1B, second rail-mounted orthopedic retractor18 b having retractor end 20 b may be used during the procedure toengage with and hold another surgical instrument in position uponactuation of lock 22 b. Thus, retractors 18 a and 18 b require extensivemanual interaction with locks 22 a and 22 b, and with retractors 18 aand 18 b themselves, to reposition and lock the respective tools inposition.

The co-manipulation surgical robot systems described herein providesuperior control and stability such that the surgeon and/or assistantmay seamlessly position various off-the-shelf surgical instruments asneeded, thus avoiding the workflow limitations inherent to both humanand mechanical solutions. For example, the robot arms of theco-manipulation surgical robot system may provide surgical assistance byholding a first surgical instrument, e.g., a laparoscope, via a firstrobot arm, and a second surgical instrument, e.g., a retractor, via asecond robot arm, stable throughout the procedure to provide an optimumview of the surgical site and reduce the variability of force applied bythe surgical instruments to the body wall at the trocar point. As willbe understood by a person having ordinary skill in the art, the robotsarms of the co-manipulation surgical robot systems described herein mayhold any surgical instrument, preferably having a long and thininstrument shaft, used for surgical procedures such as laparoscopicprocedures including, e.g., endoscopes/laparoscopes, retractors,graspers, surgical scissors, needle holders, needle drivers, clamps,suturing instruments, cautery tools, staplers, clip appliers, etc.

The co-manipulation surgical robot system further allows the surgeon toeasily maneuver both tools when necessary, providing superior controland stability over the procedure and overall safety. Any implementationsof the systems described herein enable a surgeon to directlyco-manipulate instruments while remaining sterile at the patientbedside. For example, the system may include two robot arms that may beused by the surgeon to hold both a laparoscope and a retractor. During asurgical procedure, the system may seamlessly reposition eitherinstrument to provide optimal visualization and exposure of the surgicalfield. Both instruments may be directly coupled to the robot arms of thesystem and the system may constantly monitor and record the position ofthe two instruments and/or the two robot arms throughout the procedure.Moreover, the system may record information such as the position andorientation of surgical instruments attached to the robot arm, sensorreadings related to force(s) applied at proximal and distal ends of thesurgical instruments attached to robot arms, force required to hold eachinstrument in position, endoscopic video streams, algorithm parameters,operating room 3D stream captured with an optical scanning device,including, e.g., position(s) of surgical entry port(s), position andmovements of the surgeon's hands, surgical instrument(s) position andorientation, whether or not attached to robot arms, patient position,and patient table orientation and height.

Such data may be used to develop a database of historical data that maybe used to develop the algorithms used in some implementations tocontrol one or more aspects of an operation of the system. In addition,such data may be used during a procedure to control of one or moreaspects of an operation of the system per one or more algorithms of thesystem. For example, the data may be used to assess a level of fatigueof a user of the system.

As the operator manipulates a robot arm of the co-manipulation surgicalrobot system by applying movement to the surgical instrument coupled tothe robot arm, the system may automatically transition the robot armbetween various operational modes upon determination of predefinedconditions. For example, the system may transition the robot arm to apassive mode responsive to determining that movement of the robot armdue to movement at the handle of the surgical instrument is less than apredetermined amount for at least a predetermined dwell time period,such that in the passive mode, the robot arm maintains a staticposition, e.g., to prevent damage to the equipment and/or injury to thepatient. Additionally, the system may transition the robot arm to aco-manipulation mode responsive to determining that force applied at therobot arm due to force applied at the handle of the surgical instrumentexceeds a predetermined threshold, such that in the co-manipulationmode, the robot arm is permitted to be freely moveable responsive tomovement at the handle of the surgical instrument for performinglaparoscopic surgery using the surgical instrument, while a firstimpedance is applied to the robot arm in the co-manipulation mode toaccount for weight of the surgical instrument and the robot arm.Moreover, the system may transition the robot arm to a haptic moderesponsive to determining that at least a portion of the robot arm isoutside a predefined haptic barrier, such that in the haptic mode, asecond impedance greater than the first impedance is applied to therobot arm, thereby making movement of the robot arm responsive tomovement at the handle of the surgical instrument more viscous in thehaptic mode than in the co-manipulation mode. The system further maytransition the robot arm to a robotic assist mode responsive todetecting various conditions that warrant automated movement of therobot arm to guide the surgical instrument attached thereto, e.g., alonga planned trajectory or to avoid a collision with another object orperson in the surgical space.

Referring now to FIG. 2, co-manipulation surgical robot system 200 isprovided. As shown in FIG. 2, system 200 may include platform 100, e.g.,a surgical cart, sized and shaped to support or more robot arms 300,e.g., robot arm 300 a and robot arm 300 b, each of robot arms 300 havingsurgical instrument coupler interface 400 for removably coupling to asurgical instrument, and a computing system operatively coupled toplatform 100 and robot arms 300. As shown in FIG. 2, system 200 furthermay include graphical user interface display 110 for displayingoperational information as well as receiving user input.

In addition, each of robot arms 300 further may include indicators 334for visually indicating the operational mode associated with therespective robot arm in real-time. For example, indicators 334 may bepositioned on at least the elbow joint of the robot arm. Additionally oralternatively, indicators 334 may be placed elsewhere on system 200,e.g., on platform 100, on display 110, etc. Moreover, indicators 334 mayinclude lights, e.g., LED lights, that may illuminate in a variety ofdistinct colors and in distinct patterns, e.g., solid on or blinking.For example, each operational mode of system 200 may be associated witha uniquely colored light, such as red, yellow, blue, green, purple,white, orange, etc. Accordingly, indicators 334 may indicate atransition from one operational mode to another operational mode.

As shown in FIG. 2, platform 100 may include vertical extenders 106 forindependently moving robot arm 300 a and robot arm 300 b verticallyrelative to platform 100, and horizontal extenders 108 for independentlymoving robot arm 300 a and robot arm 300 b horizontally relative toplatform 100, to thereby permit the operator flexibility in positioningrobot arms 300 relative to the patient. Moreover, platform 100 mayinclude a plurality of wheels 104, e.g., castor wheels, to providemobility of platform 100, and accordingly, robot arms 300, within theoperating room. Wheels 104 may each include a braking mechanism whichmay be actuated to prevent movement of platform 100 via wheels 104.Accordingly, platform 100 may independently move each of robot arm 300 aand robot arm 300 b in any direction, including a first or verticaldirection toward and away from the floor, a second or horizontaldirection toward and away from the patient, and/or a third direction orhorizontal direction along a length of the patient. In some embodiments,platform 100 may move robot arm 300 a and robot arm 300 b in the samedirection simultaneously. When ready for operation, platform 100 may bemoved to a desired position at the side of the patient bed and locked inplace via wheels 104, and the vertical and horizontal positions of robotarms 300 a and 300 b may be adjusted to an optimum position relative tothe patient for the procedure via vertical extenders 106 and horizontalextenders 108, responsive to user input received by graphical userinterface display 110.

Surgical robot system 200 is configured for co-manipulation, such thatsystem 200 may assist the user or operator, e.g., a surgeon and/orsurgical assistant, by permitting the user to freely move robot arm 300a and/or robot arm 300 b due to manipulation of one or more surgicalinstruments coupled with the robot arms in response to force inputsprovided by the user to the surgical instruments. Accordingly, system200 may be configured so that it is not controlled remotely, such thatrobot arms 300 move directly responsive to movement of the surgicalinstrument coupled thereto by the operator, while compensating for themass of the surgical instrument and of the respective robot arm andproviding localized impedance along the robot arm, thereby increasingthe accuracy of the movements or actions of the operator as the operatormanipulates the surgical instrument.

System 200 may be particularly useful in laparoscopic surgicalprocedures and/or other surgical procedures that utilize long and thininstruments that may be inserted, e.g., via cannulas, into the body of apatient to allow surgical intervention. As will be understood by aperson having ordinary skill in the art, system 200 may be used for anydesired or suitable surgical operation. Moreover, system 200 may be usedin conjunction or cooperation with video monitoring provided by one ormore cameras and/or one or more endoscopes so that an operator of system200 may view and monitor the use of the instrument coupled with robotarms 300 via coupler interface 400. For example, robot arm 300 a may beremoveably coupled with and manipulate an endoscope, while robot arm 300b may be may be removeably coupled with and manipulate a surgicalinstrument.

Referring now to FIGS. 3A to 3D, a surgical support arm, e.g., robot arm300, is provided. As described above, system 200 may include a pluralityof robot arms, e.g., robot arm 300 a and robot arm 300 b. however, aseach robot arm may be constructed identically, only a single robot armis described with regard to FIGS. 3A to 3D for brevity, collectively asrobot arm 300. Aspects of the robot arms described herein may utilizestructures from U.S. Pat. No. 10,118,289 to Louveau, the entire contentsof which are incorporated herein by reference. Robot arm 300 may includea plurality of arm segments/links and a plurality of articulation joints106 extending from a base portion. For example, robot arm 300 mayinclude a base portion, a shoulder portion, an elbow portion, and awrist portion, thereby mimicking the kinematics of a human arm. As shownin FIG. 3A, robot arm 300 may include a base, which includes baseportion 302 rotatably coupled to shoulder portion 304 at base joint 303.For example, shoulder portion 304 may sit on top of base portion 302,and may be rotated relative to base portion 302 about axis Q1 at basejoint 303. In some embodiments, robot arms 300 may be interchanged,swapped, or coupled with the base in any desired arrangement.

Robot arm 300 further may include shoulder link 305, which includesproximal shoulder link 306 rotatably coupled to distal shoulder link308. A proximal end of proximal shoulder link 306 may be rotatablycoupled to shoulder portion 304 of the base at shoulder joint 318, suchthat proximal shoulder link 306 may be rotated relative to shoulderportion 304 about axis Q2 at shoulder joint 318. As shown in FIG. 3A,axis Q2 may be perpendicular to axis Q1. The distal end of proximalshoulder link 306 may be rotatably coupled to the proximal end of distalshoulder link 308 at joint 320, such that distal shoulder link 308 maybe rotated relative to proximal shoulder link 306 about axis Q3 at joint320. As shown in FIG. 3A, axis Q3 may be parallel to the longitudinalaxis of shoulder link 305. In addition, robot arm 300 may includeactuator 330, e.g., a lever, button, or switch, operatively coupled todistal shoulder link 308 and/or proximal shoulder link 306, such thatdistal shoulder link 308 may only be rotated relative to proximal shouldlink 306 upon actuation of actuator 330. Accordingly, axis Q3 may be a“setup” axis, such distal shoulder link 308 may be rotated and fixedrelative to proximal shoulder link 306 during a setup stage prior tooperating stage where robot arm 300 is used in a surgical procedure, asdescribed in further detail with regard to FIGS. 10A to 10D.

In some embodiments, upon actuation of actuator 330, distal shoulderlink 308 may be manually rotated in predefined increments relative toproximal shoulder link 306. Alternatively, upon actuation of actuator330, distal shoulder link 308 may be automatically rotated relative toproximal shoulder link 306 until actuator 330 is released. For example,actuator 330 may be a button or switch operatively coupled to a motoroperatively coupled to distal shoulder link 308 and/or proximal shoulderlink 306, such that upon actuation of actuator 330, the associated motorcauses distal shoulder link 308 to rotate relative to proximal shoulderlink 306. Preferably, the motor is disposed within the base of robot arm300, or alternatively, the motor may be disposed on shoulder link 305.Accordingly, actuator 330 may be a button or switch that permits dualactuation, e.g., a first actuation to cause distal shoulder link 308 torotate in a first direction relative to shoulder link 306, and a secondactuation to cause distal shoulder link 308 to rotate in a seconddirection opposite to the first direction. In some embodiments, thebutton or switch may be located on a graphical user interface such asdisplay 110.

Robot arm 300 further may include elbow link 310. A proximal end ofelbow link 310 may be rotatably coupled to a distal end of distalshoulder link 308 at elbow joint 322, such that elbow link 310 may berotated relative to distal shoulder link 308 about axis Q4 at elbowjoint 322. Robot arm 300 further may include wrist portion 311, whichmay include proximal wrist link 312 rotatably coupled to the distal endof elbow link 310 at wrist joint 324, middle wrist link 314 rotatablycoupled to proximal wrist link 312 at joint 326, and distal wrist link316 rotatably coupled to middle wrist link 314 at joint 328, as furthershown in FIGS. 4A and 4B. Accordingly, wrist portion 311 may be rotatedrelative to elbow link 310 about axis Q5 at wrist joint 324, middlewrist portion 314 may be rotated relative to proximal wrist link 312about axis Q6 at joint 326, and distal wrist link 316 may be rotatedrelative to middle wrist link 314 about axis Q7 at joint 328. Inaddition, as shown in FIG. 4B, robot arm 300 may include actuator 332,e.g., a lever, button, or switch, operatively coupled to elbow link 310and/or proximal wrist link 312, such that proximal wrist link 312 mayonly be rotated relative to elbow link 310 upon actuation of actuator332. Accordingly, axis Q5 may be a “setup” axis, such proximal wristlink 312 may be rotated and fixed relative to elbow link 310 during asetup stage prior to operating stage where robot arm 300 is used in asurgical procedure. In some preferred embodiments, upon actuation ofactuator 332, proximal wrist link 312 may be manually rotated inpredefined increments relative to elbow link 310, thereby removing thenecessity of having additional motors and/or electronics at the distalregion of robot arm 300. Alternatively, upon actuation of actuator 330,proximal wrist link 312 may be automatically rotated relative to elbowlink 310 until actuator 332 is released.

Referring again to FIG. 3A, robot arm 300 may include a plurality ofmotors, e.g., motors M1, M2, M3, which may all be disposed within thebase of robot arm 300. Each of motors M1, M2, M3 may be operativelycoupled to a respective joint of robot arm 300, e.g., base joint 303,shoulder joint 318, and elbow joint 322, to thereby apply a localizedimpedance at the respective joint. For example, motors M1, M2, M3 mayproduce an impedance at any of base joint 303, shoulder joint 318, andelbow joint 322, respectively, to thereby effectively apply an impedanceat the distal end of robot arm, e.g., at the attachment point with thesurgical instrument, to improve the sensations experienced by theoperator during manipulation of the surgical instrument as well as theactions of the operator during surgical procedures. For example,impedance may be applied to the distal end of robot arm 300, andaccordingly the surgical instrument coupled thereto, to provide asensation of a viscosity, a stiffness, and/or an inertia to the operatormanipulating the surgical instrument. Moreover, applied impedances maysimulate a tissue density or stiffness, communicate surgical boundariesto the operator, and may be used to direct a surgical instrument along adesired path, or otherwise. In some embodiments, the motors may actuatethe respective joints to thereby cause movement of robot arm 300 aboutthe respective joints. Accordingly, axis Q1, axis Q2, and axis Q4 mayeach be a “motorized” axis, such that motors M1, M2, M3 may apply animpedance/torque to base joint 303, shoulder joint 318, and elbow joint322, respectively, to inhibit or actuate rotation about the respectiveaxis. As described in further detail below, motors M1, M2, M3 may becontrolled by a processor of the co-manipulation robot platform. Withthree motorized axes, some implementations of robot arm 300 may applyforce/torque at the distal end of robot arm 300 in three directions tothereby move the surgical instrument coupled to the distal end of robotarm 300 in three degrees of freedom.

Axis Q6 and axis Q7 may be a “passive” axis, such that middle wrist link314 may be rotated relative to proximal wrist link 312 without anyapplied impedance from system 200, and distal wrist link 316 may berotated relative to middle wrist link 314 without any applied impedancefrom system 200. The distal end of distal wrist link 316 may includesurgical instrument coupler interface 400 for removably coupling with asurgical instrument, e.g., via coupler body 500 as shown in FIGS. 4A and4B, which may be removeably coupled to the surgical instrument and tocoupler interface 400, as described in further detail below.Alternatively, wrist portion 11 may include a passive ball joint at theattachment point with the surgical instrument, as described in U.S. Pat.No. 10,582,977, the entire disclosure of which is incorporated herein byreference.

Referring again to FIG. 3A, robot arm 300 further may include aplurality of encoders, e.g., encoders E1-E7, disposed on at least someof the plurality of joints of robot arm 300. For example, encoder E1 formeasuring angulation of between base portion 302 and shoulder portion304 may be disposed on or adjacent to base joint 303 within the base,encoder E2 for measuring angulation of between shoulder portion 304 andproximal shoulder link 306 may be disposed on or adjacent to shoulderjoint 318 within the base, encoder E3 for measuring angulation ofbetween proximal shoulder link 306 and distal shoulder link 308 may bedisposed on or adjacent to joint 320, encoder E4 for measuringangulation of between distal shoulder link 308 and elbow link 310 may bedisposed adjacent to motor M3 operatively coupled to elbow joint 322within the base as transmission of rotational motion at elbow joint 322is achieved via a connection rod extending from the base to elbow joint32, encoder E5 for measuring angulation of between elbow link 310 andproximal wrist link 312 may be disposed on or adjacent to wrist joint324, encoder E6 for measuring angulation of between proximal wrist link312 and middle wrist link 314 may be disposed on or adjacent to joint326, and encoder E7 for measuring angulation of between middle wristlink 314 and distal wrist link 316 may be disposed on or adjacent tojoint 328. Alternatively, encoder E4 may be disposed on or adjacent toelbow joint 322. The encoders may be absolute encoders or otherposition/angulation sensors configured to generate data for accuratelydetermining the position and/or angulation of corresponding links at therespective joint and/or the exact position of the surgical instrumentcoupled to the distal end of robot arm 300. Accordingly, the exactposition of each link, joint, and the distal end of robot 300 may bedetermined based on measurements obtained from the plurality ofencoders. Preferably, a redundant encoder is disposed at each locationalong robot arm 300 where an encoder is placed, to provide more accurateposition data, as well as, to detect a fault condition, as described infurther detail below.

Prior to attachment with a surgical instrument, robot arm 300 may bemanually manipulated by a user, e.g., to position robot arm 300 is adesired position for coupling with the surgical instrument. For example,the user may manually manipulate robot arm 300 via wrist portion 11,actuator 330, and/or actuator 332. Upon actuation of actuator 330, theuser may manually rotate distal shoulder link 308, and upon actuation ofactuator 332, the user may manually manipulate proximal wrist portion312. Upon attachment to the surgical instrument, robot arm 300 may stillbe manipulated manually by the user exerting force, e.g., one or morelinear forces and/or one or more torques, directly to robot arm 300;however, during the laparoscopic procedure, the operator preferablymanipulates robot arm 300 only via the handle of the surgicalinstrument, which applies force/torque to the distal end of the robotarm 300, and accordingly the links and joints of robot arm 300. As theoperator applies a force to the surgical instrument attached to robotarm 300, thereby causing movement of the surgical instrument, robot arm300 will move responsive to the movement of the surgical instrument toprovide the operator the ability to freely move surgical instrumentrelative to the patient. As described in further detail below, robot arm300 may apply an impedance to account for weight of the surgicalinstrument and of robot arm 300 itself, e.g., gravity compensation, asthe operator moves the surgical instrument, thereby making it easier forthe operator to move the instrument despite gravitational forces and/orinertial forces being exerted on the robot arm and/or the surgicalinstrument. As will be understood by a person having ordinary skill inthe art, robot arm 300 may include less or more articulation joints thanis shown in FIG. 3A, as well as a corresponding number of motors andencoders/sensors.

Referring now to FIG. 4C, a close-up view of the coupling mechanism ofcoupler interface 400 and coupler body 500 is provided. Couplerinterface 400 may be coupled to the distal end of distal wrist link 316using any suitable fasteners or connectors, e.g., magnets, screws, pins,clamps, welds, adhesive, rivets, and/or any other suitable faster or anycombination of the foregoing. As shown in FIG. 4C, coupler interface 400may be coupled with the distal end of distal wrist portion 316 usingfastener 410 which may be threaded or have other features that enablefastener 410, and accordingly coupler interface 400 to be selectivelyattached to distal wrist portion 316. Fastener 410 may be coupled withinsert element 408 having an opening therein to receive fastener 410,positioned at or in the distal end of distal wrist portion 316. In someembodiments, fastener 410 may be a pin or may have other features suchas a ball, a latch, or otherwise to permit fastener 410 to selectivelycouple with distal wrist portion 316.

Coupler body 500, which may have opening 514 sized and shaped toslidably and releasably receive the elongated shaft of a surgicalinstrument therethrough, may be removably coupled with coupler interface400. For example, coupler body 500 may be removeably coupled to couplerbody 500 via a magnetic connection, to thereby facilitate efficientattachment and detachment between coupler body 500 and coupler interface400, e.g., by overcoming the magnetic coupling force between couplerbody 500 and coupler interface 400. Accordingly, as shown in FIG. 4C,coupler body 500 may have one or more magnets 506 extending away from asurface of coupler body 500 that, in an assembled state, contacts asurface of coupler interface 400. Alternatively, in embodiments that donot have a coupler interface, magnets 506 may directly contact thedistal end of distal wrist portion 316.

Accordingly, coupler interface 400 or the distal end of distal wristportion 316 may have a ferrous base component configured to receive andmagnetically couple with magnets 506 of coupler body 500 so that couplerbody 500 may be removably coupled with coupler interface 500 and/or thedistal end of distal wrist portion 316. FIG. 4D illustrates surgicalinstrument coupler interface 400. As shown in FIG. 4D, coupler interface400 may have recessed portion 404 sized and shaped to receive thecomplementary geometry of coupler body 500, defined by ridges 402.Accordingly, when the complementary geometry of coupler body 500 isreceived in recessed portion 404 in an assembled state, rotationalmovement of coupler body 500 relative to coupler interface 400 may belimited or otherwise prevented.

In addition, coupler interface 400 may have one or more recesses ordepressions 406 sized and shaped to receive one or more magnets 506therein. Coupler interface 400 may have a ferrous base component ormagnets within recesses 406 to magnetically couple with magnets 506. Forexample, the magnets within recesses 406 may have a south magnetic poleand magnets 506 may have a north magnetic pole, or vice versa. Moreover,the polarity of the magnets can ensure appropriate coupling orientation.Recesses 406 may be sized and shaped to limit or otherwise preventmovement between coupler body 500 and coupler interface 400 in anydirection that is radial or normal to an axial (e.g., longitudinal)centerline of magnets 506 when coupler body 500 is in an assembled statewith coupler interface 400. As will be understood by a person havingordinary skill in the art, coupler interface 400 may have less or morethan two recesses 406, such that coupler body 500 will have acorresponding amount of magnets.

Referring now to FIGS. 5A and 5B, coupler body 500 is provided. As shownin FIG. 5A, coupler body 500 may have one or more magnets 506 disposedon portion 502 having a geometry complementary to recessed portion 404of coupler interface 400, as described above, to facilitate alignmentbetween coupler body 500 and coupler interface 400. In addition, couplerbody 500 may have one or more grooves 504 sized and shaped to engagewith complementary ridges 402 of coupler interface 400. Grooves 504 andridges 402 may interact to assist with the alignment of coupler body 500with coupler interface 400 by limiting or otherwise preventing movementbetween coupler body 500 and coupler interface 400 in at least twodirections D1 and D2, as shown in FIG. 4C. Accordingly, in an assembledstate, coupler body 500 may be prevented from moving in any axialdirection relative to coupler interface 400.

As shown in FIGS. 5A and 5B, coupler body 500 may have first portion 508and second portion 510. First portion 508 may be coupled with, orintegrally formed with, second portion 510, e.g., via hinge 512, whichmay be a living hinge formed from the same material as first and secondportions 508, 510 and/or integrally formed with first and secondportions 508, 510 so that second portion 510 may be moved or rotatedrelative to first portion 508 to cause opening 514 defined by firstportion 508 and second portion 510 to expand (increase in size) orcontract (decrease in size). First portion 508 and second portion 510may form a clamp that may constrict about the elongated shaft of asurgical instrument that is positioned in opening 514 as screw 516,e.g., a thumb screw, is tightened, to couple the instrument 112 with thecoupler body 141. Accordingly, coupler body 500 may transition between afirst, unsecured/open state or position and a second, secured/closedstate or position.

The diameter of opening 514 may be selected based on the surgicalinstrument to be coupled to coupler body 500. For example, a couplerbody may be selected from a plurality of coupler bodies, each couplerbody having an opening sized and shaped to receive the elongate shaft ofa specific surgical instrument having a predefined elongated shaftdiameter such as a laparoscopic or other surgical instrument includingsurgical instruments used for orthopedic and trauma surgery (OTS), aneedle holder, clamp, scissors, etc. Coupler body 500 may be coupledwith the surgical instrument at any desired axial position on thesurgical instrument.

As shown in FIG. 5C, coupler body 500 may include recess 520 extendingthrough second portion 510 and recess 522 extending through at least aportion of first portion 508. Recess 520 is aligned with recess 522 forreceiving locking portion 518 of screw 516. For example, locking portion518 may have a male threaded surface, and recesses 520, 522 may have afemale threaded surface to engage with locking portion 518. Screw 516may be loosened by hand to open or expand opening 514 so that thesurgical instrument may be removed, repositioned, rotated, and/or slid,etc. Once coupler body 500 is coupled with the surgical instrument,e.g., via screw 516, coupler body 500 and the surgical instrument thatis coupled with the coupler body 500 may be removeably coupled withcoupler interface 400, via magnets 506.

Opening 514 may be defined by a first semi-circular cutout in firstportion 508 and a second semi-circular cutout in the second portion 510of coupler body 500, to thereby engage with the circular outer surfaceof the elongate shaft of a surgical instrument. Opening 514 may include,e.g., rubber pads, sheets, bumps, O-rings, projections, or othercomponents or features configured to contact and grip the outer surfaceof the elongated shaft of the surgical instrument. For example, therubber material may be a silicone rubber or any other suitable type ofrubber. Accordingly, once coupler body 500 is coupled with the surgicalinstrument, e.g., by securing screw 516, the surgical instrument may beat least inhibited or otherwise prevented from moving axially, e.g., thedirection along the longitudinal axis of the surgical instrument, or, insome embodiments, moving axially and rotationally, relative to couplerbody 500 in the secured state. Preferably, the surgical instrumentcoupled with coupler body 500 may be freely rotated by an operatorrelative to coupler body 500, while axial movement of the surgicalinstrument relative to coupler body 500 is inhibited or otherwiseprevented in the secured state. For example, the frictional forcebetween the outer surface of the elongated shaft of the surgicalinstrument and the inner surface of coupler body 500 defining opening514 may be selected such that rotation of the surgical instrumentrelative to coupler body 500 requires less force that axial movement ofthe surgical instrument relative to coupler body 500 in the securedstate. Accordingly, coupler 500 may be configured to account fordiametric variations and surface variations (including variations in acoefficient of friction of the surface) of the surgical instruments.

In some embodiments, the surgical instrument may be moved in an axialdirection relative to coupler body 500 upon the application of at leasta threshold force on the surgical instrument relative to coupler body500, or upon actuation of a release or a state change of coupler body500. For example, such actuation may be achieved by, e.g., pressing abutton, loosening a locking screw such as locking screw 516 or otherconnector, moving a dial, or otherwise changing coupler body 500 and/orcoupler interface 400 from a second, secured state to a first, unsecuredstate. Accordingly, the surgical instrument may be axially repositionedrelative to coupler body 500 by loosening screw 516 or otherhand-operated fastener or fastening mechanism such as a clamp in couplerbody 500, repositioning the surgical instrument in the desired axialposition, and re-tightening screw 516 or other hand-operated fastener orfastening mechanism. Coupler body 500 may be disposable, oralternatively, may be sterilizable such that it may sterilized betweensurgical procedures.

As described above, the diameter of the opening of the coupler body maybe selected based on the surgical instrument to be coupled to thecoupler body. Most commonly used laparoscopic surgical instruments havea predefined, known elongated shaft diameter, and thus the numerouscoupler bodies may be provided, each having an opening sized and shapedto receive and engage with a specific surgical instrument. For example,FIG. 6A illustrates coupler body 600 having opening 614 sized and shapedto receive a 5 mm diameter surgical instrument, e.g., retractor device12. Coupler body 600 may be constructed similar to coupler body 500. Forexample, coupler body 600 may include first portion 608 coupled tosecond portion 610 via hinge portion 612, and recesses 620, 622 forsecurely receiving locking portion 618 of screw 616. As shown in FIG.6B, coupler body 600 may receive elongated shaft 12 a of retractor 12through opening 614, e.g., from the operating end of retractor 12, suchthat coupler body 600 may be slid over elongated shaft 12 a untilcoupler body 600 engages with proximal portion 12 b of retractor 12, asshown in FIG. 6C. Preferably, coupler body 600 is coupled to retractor12 when coupler body 600 contacts proximal portion 12 b as this pointalong retractor 12 is fixed, thereby providing a consistent point ofreference for calculating force measurements, as described in furtherdetail below. Accordingly, when coupler body 600 is in the desiredlocation along the elongated shaft of retractor 12, e.g., adjacent toproximal portion 12 b, screw 616 may be coupled to coupler body 600 tosecure coupler body 600 to retractor 12. As described above, couplerbody 600 is secured to retractor 12 such that rotational movement ofretractor 12 relative to coupler body 600 is permitted, while axialmovement of retractor 12 relative to coupler body 600 is constrained,e.g., the force required to move retractor 12 relative to coupler body600 is much higher than the force required to rotate retractor 12relative to coupler body 600.

FIG. 7A illustrates coupler body 700 having opening 714 sized and shapedto receive a 10 mm diameter surgical instrument, e.g., laparoscopedevice 10. Coupler body 700 may be constructed similar to coupler body600. For example, coupler body 700 may include first portion 708 coupledto second portion 710 via hinge portion 712, and recesses 720, 722 forsecurely receiving locking portion 718 of screw 716. As shown in FIG.7B, coupler body 700 may receive elongated shaft 10 a of laparoscopedevice 10 through opening 714, e.g., from the operating end oflaparoscope 10, such that coupler body 700 may be slid over elongatedshaft 10 a until coupler body 700 engages with proximal portion 10 b oflaparoscope 10, as shown in FIG. 7C. Preferably, coupler body 700 iscoupled to laparoscope 10 when coupler body 700 contacts proximalportion 10 b as this point along laparoscope 10 is fixed, therebyproviding a consistent point of reference for calculating forcemeasurements, as described in further detail below. Accordingly, whencoupler body 700 is in the desired location along the elongated shaft oflaparoscope 10, e.g., adjacent to proximal portion 10 b, screw 716 maybe coupled to coupler body 700 to secure coupler body 700 to laparoscope10. As described above, coupler body 700 is secured to laparoscope 10such that rotational movement of laparoscope 10 relative to coupler body700 is permitted, while axial movement of laparoscope 10 relative tocoupler body 700 is constrained, e.g., the force required to movelaparoscope 10 relative to coupler body 700 is much higher than theforce required to rotate laparoscope 10 relative to coupler body 700.

With the appropriate sized coupler body coupled to the selected surgicalinstrument, the coupler body may be removeably coupled to couplerinterface 400 of robot arm 300. Coupler body 500 and coupler interface400 may be configured for single-handed coupling, such that an operatormay couple coupler body 500, and accordingly the surgical instrumentcoupled thereto, to coupler interface 400 of robot arm 300 using asingle hand. Preferably, a surgical drape may be pinched or clampedbetween the coupler body and coupler interface 400, and draped overrobot arm 300 to maintain sterility of the surgical space and preventcontact with non-sterile components of robot arm 300. Accordingly, thesterile drape may pass continuously (e.g., without a hole, a slit, orany other type of opening) between the coupler body and the couplerinterface such that the coupler body is on a first side of the steriledrape and the coupler interface, robot arm 300, and/or other componentsof system 200 are on the other side of the sterile drape. In someembodiments, the coupler body may be integrated with the surgical drape.Additionally or alternatively, the surgical drape may include an adapterintegrated therewith, such that coupler body 500 may be coupled tocoupler interface 400 via the adapter, e.g., the adapter may bepositioned between coupler body 500 and coupler interface 400.

Referring now to FIGS. 8A and 8B, robot arm 300 may be positioned in asurgical drape-ready configuration. As shown in FIG. 8A, robot arm 300may be extended such that wrist portion 311, elbow link 310, andshoulder link 305 extend away from shoulder portion 304 of the base topermit a surgical/sterile drape to be draped over each component ofrobot arm 300. Moreover, as shown in FIG. 8B, when there are two robotarms, e.g., robot arm 300 a and robot arm 300 b, robot arm 300 a androbot arm 300 b may be angled away from each other, e.g., by rotatingshoulder portion 304 a relative to base portion 302 a of robot arm 300 aand by rotating shoulder portion 304 b relative to base portion 302 b ofrobot arm 300 b, such that wrist portion 311 a, elbow link 310 a, andshoulder link 305 a extend away from wrist portion 311 b, elbow link 310b, and shoulder link 305 b. This configuration permits efficient andaccessible draping of the respective robot arms with a surgical/steriledrape. Moreover, in the extended position, the robot arms may be outsidethe virtual haptic boundary, such that the robot arms are in the hapticmode and a high level of impedance is applied to the robot arms therebymaking movement of the robot arms more viscous, which makes it easierfor the operator to drape the robot arms, yet provide movement theretoif necessary. For example, FIG. 9A illustrates a single robot arm 300draped with sterile drape 800, and FIG. 9B illustrates robot arms 300 a,300 b draped with sterile drapes 800 a, 800 b, respectively.

Sterile drape 800 may be completely closed at an end portion thereof. Insome embodiment, sterile drape 800 may have an opening (that canoptionally have a sterile seal or interface) in a distal portion thereofthat a portion of robot arm 300, coupler interface 400, coupler body500, and/or the surgical instrument may pass through. Drapes having asealed end portion without any openings, and being sealed along a lengththereof may provide a better sterile barrier for system 200.Accordingly, all of robot arm 300 may be located inside sterile drape800 and/or be fully enclosed within sterile drape 800, except at anopening at a proximal end of sterile drape 800, e.g., near the base ofrobot arm 300). In some embodiments, coupler body 500 and couplerinterface 400 may have electrical connectors to produce an electronicconnection between robot arm 300 and the surgical instrument.Accordingly, the electrical signals may be transmitted through steriledrape 800. Alternatively, sterile drape 800 may include an opening suchthat electrical wires or other components may pass through the openingto provide a wired communication channel to electrical components thatmay include, e.g., memory chips for calibration, radiofrequency probesfor ablation, cameras, and other electronic components. The surgicalinstrument and the coupler body may instead be passive or non-electronicsuch that no electrical wires need pass through sterile drape 800.

Referring now to FIGS. 10A to 10D, rotation of distal shoulder link 308relative to proximal shoulder link 306 of shoulder link 305 is provided.As described above, axis Q3 may be a “setup” axis, such that distalshoulder link 308 may be rotated relative to proximal shoulder link 306upon actuation of actuator 330 during a setup stage of robot arm 300,e.g., prior to operation of robot arm 300 in a surgical procedure. Asshown in FIG. 10A, shoulder portion 304 optionally may be initiallyrotated relative to base portion 302 to a desired position, therebycausing rotation of all the link distal to proximal shoulder link 306,which is coupled to shoulder portion 304, to rotate relative to baseportion 302 and provide ample space for rotation of robot arm 300 aboutjoint 320. Moreover, as shown in FIG. 10, wrist portion 311 may be atleast partially extended away from base portion 302 so as to not collidewith any components of robot arm 300 upon rotation of robot arm 300about joint 320. As shown in FIG. 10B, actuator 330 must be actuated topermit rotation of distal shoulder link 308 relative to proximalshoulder link 306 at joint 320. FIG. 10C illustrates robot arm 300 in adesirable location for a specific laparoscopic procedure upon rotationof distal shoulder link 308 relative to proximal shoulder link 306. FIG.10D illustrates robot arm 300 a in the desirable location upon rotationof distal shoulder link 308 a relative to proximal shoulder link 306 a,relative to robot arm 300 b.

Referring now to FIGS. 11A and 11B, an exemplary co-manipulation robotsurgical system having an optical scanner is provided. As shown in FIG.11A, the system may be constructed similar to system 200 of FIG. 2,having a plurality of robot arms, e.g., robot arm 300 a and robot arm300 b. As described above, although only two robot arms are shown inFIG. 11A, less or more robot arms may be used in conjunction withoptical scanner 1100. In addition, the system may include opticalscanner 1100, e.g., a LiDAR scanner or other suitable optical scanningdevice such as an RGBD camera or sensor, RGB camera with machinelearning, a time-of-flight depth camera, structured light, multipleprojection cameras, a stereo camera, ultrasound sensors, laser scanner,other type of coordinate measuring area scanner, or any combination ofthe foregoing. For example, the LiDAR camera/scanner may be capable ofrecording both color (RGB) and the Depth (D) of the surgical field, andmay include, for example, an Intel RealSense LiDAR Camera L515 or anIntel RealSense Depth Camera D435i (made available by Intel, SantaClara, Calif.) or other LiDAR or depth cameras having similar orsuitable specifications including, without limitation, any of thefollowing specifications: (i) range: 25 cm to 500 cm; depth accuracy: 5mm or approximately 5 mm; depth field of view: 70×55 or approximately70×55 (degrees); depth output resolution: 1024×768 pixels orapproximately 1024×768 pixels; depth/RGB frame rate: 30 frames persecond; RGB frame resolution: 1920×1080; and/or RGB field of view: 70×43degrees or approximately 70×43 degrees. The LiDAR scanner or opticalscanner further may include both a ¼-20 UNC thread or 2× M3 threadmounting points. As will be understood by a person having ordinary skillin the art, optical scanner 1100 may be used in other co-manipulationrobot surgical systems described herein, e.g., system 200, or anyvariations thereof.

As shown in FIG. 11A, the platform supporting robot arms 300 a, 300 bmay support optical scanner 1100, and any other electronics, wiring, orother components of the system, such that optical scanner 1100 ismounted in a fixed location relative to the other objects in thesurgical space, and the position and orientation of optical scanner 1100is known or may be determined with respect to the global coordinatesystem of the system, and accordingly, the robot arms. This allows alldata streams to be transformed into a single coordinate system fordevelopment purposes. For example, optical scanner 1100 may be supportedon a rod or shaft, e.g., rod 1102, which may have an adjustable heightor otherwise be adjustable in any direction, e.g., up/down, left/right,toward/away from the patient, to allow optical scanner 1100 to gain anoptimum field-of-view or position relative to the other components ofthe system, for example, robot arms 300 a, 300 b, the surgicalinstruments attached thereto, the surgeon, and/or surgical assistant.Moreover, telemetry data captured by optical scanner 1100, e.g.,indicative of the movements of the surgeon's hands, other body parts,and other components of the system, may be recorded to provide a richand detailed dataset describing the precise movements and forces appliedby the surgeon throughout the procedure.

For example, the data obtained may be used to optimize the proceduresperformed by the system including, e.g., automatic servoing (i.e.,moving) of one or more portions of robot arm 300. By tracking thetendency of the surgeon to keep the tools in a particular region ofinterest and/or the tendency of the surgeon to avoid moving the toolsinto a particular region of interest, the system may optimize theautomatic servoing algorithm to provide more stability in the particularregion of interest. In addition, the data obtained may be used tooptimize the procedures performed by the system including, e.g.,automatic re-centering of the field of view of the optical scanningdevices of the system. For example, if the system detects that thesurgeon has moved or predicts that the surgeon might move out of thefield of view, the system may cause the robot arm supporting the opticalscanning device, e.g., a laparoscope, to automatically adjust thelaparoscope to track the desired location of the image as the surgeonperforms the desired procedure. This behavior may be surgeon-specificand may require an understanding of a particular surgeon's preferencefor an operating region of interest. Thus, the system may control therobot arms pursuant to specific operating requirements and/orpreferences of a particular surgeon.

FIG. 12 shows the system having optical scanner 1100 in operation duringa laparoscopic procedure. As shown in FIG. 12, an optional additionaloptical scanner, e.g., camera 1200, may be utilized to provide anadditional point of view, e.g., redundant measurement of the movementsof the instruments held by the robot arms, and/or provide a video streamof the surgical scene, e.g., via streaming, for monitoring and analysis.As shown in FIG. 12, the system may include two robot arms, e.g., robotarms 300 a, 300 b, such that robot arm 300 a holds laparoscope 10 in afixed position relative to the patient, while the surgeon operates andmanipulates retractor 12, which is coupled to the distal end of robotarm 300 b. Moreover, during the surgical procedure, robot arms 300 a,300 b may be draped with sterile drapes 800 a, 800 b, respectively. Asdescribed above, the surgeon may freely manipulate retractor 12 whileretractor 12 is coupled to robot arm 300 b, thereby causing movement ofrobot arm 300 b due to movement of retractor 12 by the surgeon, andwhile robot arm 300 b accounts for weight of retractor 12 and robot arm300 b. During the surgical procedure, optical scanner 1100 may be usedto monitor an identity, position, orientation, and/or movement of thesurgical instrument coupled to robot arm 300 a, e.g., laparoscope 10,and an identity, position, orientation, and/or movement of the surgicalinstrument coupled to robot arm 300 b, e.g., retractor 12, as well as ifeither surgical instrument is detached from the respective robot arm,either intentionally or unintentionally. Moreover, optical scanner 1100may be used to monitor an identity, position, orientation, and/ormovement/displacement of any of trocars Tr to ensure proper alignment ofthe robot arms and/or surgical instruments relative to the respectivetrocars. The system may be used in a surgical procedure having one, two,three, four, or more trocars, depending on the surgical procedureintended to be performed by the system.

FIGS. 13A and 13B illustrate exemplary data produced by optical scanner1100. For example, FIG. 13A illustrates image data captured by opticalscanner 1100, and FIG. 13B illustrates a depth map of at least someobjects within the surgical space generated from the data captured byoptical scanner 1100. Specifically, optical scanner 1100 may create adepth map, e.g., point clouds, where each pixel's value is related tothe distance from optical scanner 1100. For example, the differencebetween pixels for a first object (such as a first surgical instrument)and a second object (for example, a trocar) will enable the system tocalculate the distance between the surgical instrument and the trocar.Moreover, the difference between pixels for a first object (such as afirst surgical instrument) at a first point in time and the first objectat a second point in time will enable the system to calculate whetherthe first object has moved, the trajectory of movement, the speed ofmovement, and/or other parameters associated with the changing positionof the first object.

As shown in FIGS. 13A and 13B, surgeon S is manipulating surgical toolsand/or the draped robot arm (DA) and the undraped robot arm (UA) thatare positioned relative to insufflated abdomen (A). As described above,the data streams from the robot arms, the camera feed from thelaparoscope, the data acquired from optical scanner 1100, as well asdata optionally captured from one or more imaging devices disposed on astructure adjacent to the robot arms, the walls, ceiling, or otherstructures within the operating room, may be recorded, stored, and usedindividually or in combination to understand and control the surgicalsystem and procedures of the surgical system. The foregoing components,devices, and combinations thereof are collectively referred to herein asoptical scanners or optical scanning devices.

For example, the system may measure and record any of the followingwithin the coordinate space of the system: motion of the handheldsurgical instruments manipulated by the surgeon (attached to or apartfrom a robot arm); the presence/absence of other surgical staff (e.g.,scrub nurse, circulating nurse, anesthesiologist, etc.); the height andangular orientation of the surgical table; patient position and volumeon the surgical table; presence/absence of the drape on the patient;presence/absence of trocar ports, and if present, their position andorientation; gestures made by the surgical staff; tasks being performedby the surgical staff; interaction of the surgical staff with thesystem; surgical instrument identification; attachment or detachment“action” of surgical instruments to the system; position and orientationtracking of specific features of the surgical instruments relative tothe system (e.g., camera head, coupler, fiducial marker(s), etc.);measurement of motion profiles or specific features in the scene thatallow for the phase of the surgery to be identified; position,orientation, identity, and/or movement of any other instruments,features, and/or components of the system or being used by the surgicalteam.

The system may combine measurements and/or other data described abovewith any other telemetry data from the system and/or video data from thelaparoscope to provide a comprehensive dataset with which to improve theoverall usability, functionality, and safety of the co-manipulationrobot-assisted surgical systems described herein. For example, as thesystem is being setup to start a procedure, optical scanner 1100 maydetect the height and orientation of the surgical table. Thisinformation may allow the system to automatically configure the degreesof freedom of platform 200 supporting robot arms 300 to the desired orcorrect positions relative to the surgical table. Specifically, opticalscanner 1100 may be used to ensure that the height of platform 100 isoptimally positioned to ensure that robot arms 300 overlap with theintended surgical workspace. Moreover, based on the data obtained byoptical scanner 1100, the system may alert the surgical staff of apotential collision (either during setup or intra-operatively) betweenthe system and other pieces of capital equipment in the operating room,e.g., the surgical table, a laparoscopic tower, camera booms, etc., aswell as with a member of the surgical staff, e.g., an inadvertent bumpby the staff member. The system may use this information to recommend arepositioning of platform 100 and/or other components of the system, thesurgical table, and/or patient, and/or prevent the robot arm fromswitching to the co-manipulation mode as a result of the force appliedto the robot arm by the collision with the staff member, even if theforce exceeds the predetermined force threshold of the robot arm.

In addition, the data obtained from optical scanner 1100 may be used tomonitor the progress of setup for a surgical procedure and may becombined with the known state of the system to inform remote hospitalstaff (e.g., the surgeon) of the overall readiness to start theprocedure. Such progress steps may include: (i) patient on table; (ii)patient draped; (iii) sterile instruments available; (iv) robot armdraped; (v) trocar ports inserted; and (vi) confirmation thatinstruments (e.g., a laparoscope and retractor) are attached to therobotic arms of system. For example, the data obtained from opticalscanner 1100 may include detected gestures indicative of the systemstate (e.g., system is draped), readiness to start the procedure, etc.,and further may be used to prepare the system for the attachment ordetachment of a surgical instrument.

In addition, optical scanner 1100 may identify the specific surgeoncarrying out the procedure, such that the system may use the surgeon'sidentity to load a system profile associated with the particular surgeoninto the system. The system profile may include information related to asurgeon's operating parameter and/or preferences, a surgeon's patientlist having parameters for each patient, the desired or requiredalgorithm sensitivity for the surgeon, the degree of freedom positioningof the support platform, etc. Examples of algorithm sensitivities thatmay be surgeon-specific include: adapting/adjusting the force requiredto transition from passive mode to co-manipulation mode (e.g., from lowforce to high force), adapting/adjusting the viscosity felt by thesurgeon when co-manipulating the robot arm (e.g., from low viscosity tohigh viscosity), etc. Moreover, the surgeon's preferences may includepreferred arrangements of robot arm 300, e.g., the positioning of thelinks and joints of robot arm 300 relative to the patient, with regardto specific surgical instruments, e.g., the preferred arrangement may bedifferent between a laparoscope and a retractor.

In some embodiments, the surgeon's preferences may be learned based ondata from past procedures and/or sensors collecting information aboutcurrent procedure including a surgeon's current pose, a surgeon'sheight, a surgeon's hand preference, and other similar factors. Forexample, the system may record when a user interacts with the system andalso record what the user does with the system, such that the datasetmay allow for surgeon preferences to be “learned” and updated over time.This learning may be done either via traditional algorithmic methods(i.e., trends over time, averaging, optical flow, etc.) or via machinelearning approaches (classification, discrimination, neural networks,reinforcement learning, etc.). FIG. 24 illustrates data flow 2400 forupdating the system configurations based on learned behaviors of theuser. As shown in FIG. 24, the system may be connected to an onlinedatabase that may store a surgeon profile and each of a plurality ofpossible data sources, which may include optical sensors, encoders,and/or other sensors, and/or a database of manually entered user input.The data sources may be associated with a given surgeon, their preferredrobot arm arrangement and operating parameters, and each procedureperformed with the system, which may allow the recording and analysis ofthe system configuration and how it changes from procedure to procedure,and within the procedure. In the case of machine learning, theco-manipulation capability of the system may be leveraged such that theuser's actions may be used to annotate the data to create a trainingdataset.

Regarding the degree of freedom positioning, a height of a surgicaltable is typically adjusted to accommodate the height of the surgeon insome operating rooms. Thus, by detecting the surgeon and loading thesurgeon's specific profile, the system may position the platform at aheight that is suitable for the respective surgeon to accommodate thepreferred height of the surgical table. In addition, the horizontaltranslation of a robot arm may depend on the size of the patient. Thus,by accessing the patient list, the system may adjust the position of thearm based on the patient's body mass index (“BMI”). For example, for apatient with a high BMI, the system may move the robot arm away from theoperating table and, for a patient with a low BMI, the system may movethe robot arm closer to the operating table. Accordingly, the systempermits the surgical team to fine-tune the position of the robot armrelative to the patient as necessary. The system further may beconfigured to access a hospital medical record database to access theprocedure type and any other medical data available (e.g., CT scanimages, x-ray images, MRI images, and/or other patient specificinformation), which may be used to inform positioning of the trocarports, and the position and orientation of platform 100 relative to thepatient.

Based on the data captured by optical scanner 1100, the system maygenerate a virtual model of the pieces of capital equipment and/or otherobjects in an operating room that are within a range of movement of therobot arms in the same co-ordinate space as the robot arms and surgicalinstruments coupled thereto, such that the virtual model may be storedand monitor, e.g., to detect potential collisions. Additionally, thesystem may track the position and orientation of each virtual model, andthe objects within the virtual models as the objects move relative toeach other, such that the system may alert the user if the proximity of(i.e., spacing between) any of the virtual models or objects falls belowa predefined threshold, e.g., within 50 mm, 75 mm, from 30 mm or less to100 mm, or more. In some embodiments, the distance threshold may bebased off the Euclidean distance between the closest points on twovirtual models, the normal distance between two surfaces of the virtualmodels, etc. Moreover, the system may stop or inhibit (e.g., prevent)further movement of a robot arm, e.g., freeze the robot arm, if theproximity of any of the virtual models or objects, e.g., a robot armreaches or falls below the predefined threshold relative to alaparoscopic tower, or the surface of the surgical table, or otherobjects within the surgical space. In addition, the system may freezethe robot arm if the system detects that the proximity between anobject, e.g., capital equipment or a member of the surgical staff otherthan the surgeon, moving toward a respective robot arm reaches or fallsbelow the predefined threshold, to thereby prevent the inadvertentmovement of the robot arm that may otherwise result from such acollision or inadvertent force, e.g., an inadvertent bump from a memberof the staff or another piece of capital equipment, etc.

Moreover, based on the data captured by optical scanner 1100, the systemmay track the motion of the handheld surgical instruments that aredirectly and independently controlled by the surgeon, that are notcoupled with the robot arm. For example, the optical scanner 1100 maytrack a clearly defined feature of the instrument, a fiducial markerattached to the instrument or to the gloves (e.g., the sterile gloves)of the surgeon, the coupler between the robot arm and the instrument, adistal tip of the instrument, and/or any other defined location on theinstrument. For example, fiducial markers may include Manus virtualreality gloves (made available by Manus, The Netherlands) or otherwearables, and/or the OptiTrack systems (made available by NaturalPoint,Corvallis, Oreg.). The following are examples of uses and purposes ofthe motion data: (i) closing a control loop between a handheldinstrument and the robot arm holding the camera, thus allowing thesurgeon to servo (i.e., move) the camera by “pointing” with a handheldinstrument; (ii) tracking information that may be used independently orin combination with other data streams to identify the phase of thesurgical procedure; (iii) to identify the dominant hand of the surgeon;(iv) to monitor metrics associated with the experience of the surgeon;(v) to identify which tools the surgeon is using and when to change themfor other tools; and/or (vi) tracking of the skin surface of thepatient, as well as the number, position and orientation of the trocarports. This data and information also may be used and computed by thesystem as part of the co-manipulation control paradigm. By measuring thetrue position and orientation of the trocar ports, the system may beprovided an additional safety check to ensure that the system levelcomputations are correct, e.g., to ensure that the actual motion of therobot arms or instrument matches a commanded motion of the robot arms orinstrument in robotic assist mode.

Based on the data captured by optical scanner 1100, the system furthermay track the which instrument is being used in a respective port, howoften instruments are swapped between ports, which ports have manuallyheld instruments versus instruments coupled to the robot arm, to monitorand determine if additional trocar ports are added, if the system isholding the instruments in place while the patient or surgical table ismoving (in which case, the system may change the operational mode of therobot arms to a passive mode and accommodate the movement byrepositioning robot arm 300 and/or platform 100), and/or otherconditions or parameters of the operating room or the system. Theknowledge of the position and orientation of the skin surface and trocarports relative to the robot arms may facilitate the implementation of“virtual boundaries” as described in further detail below.

Referring now to FIG. 14, components that may be included inco-manipulation robot platform 1400 are described. Platform 1400 mayinclude one or more processors 1402, communication circuitry 1404, powersupply 1406, user interface 1408, and/or memory 1410. One or moreelectrical components and/or circuits may perform some of or all theroles of the various components described herein. Although describedseparately, it is to be appreciated that electrical components need notbe separate structural elements. For example, platform 1400 andcommunication circuitry 1404 may be embodied in a single chip. Inaddition, while platform 1400 is described as having memory 1410, amemory chip(s) may be separately provided.

Platform 1400 may contain memory and/or be coupled, via one or morebuses, to read information from, or write information to, memory. Memory1410 may include processor cache, including a multi-level hierarchicalcache in which different levels have different capacities and accessspeeds. The memory also may include random access memory (RAM), othervolatile storage devices, or non-volatile storage devices. Memory 1410may be RAM, ROM, Flash, other volatile storage devices or non-volatilestorage devices, or other known memory, or some combination thereof, andpreferably includes storage in which data may be selectively saved. Forexample, the storage devices can include, for example, hard drives,optical discs, flash memory, and Zip drives. Programmable instructionsmay be stored on memory 1410 to execute algorithms for, e.g.,calculating desired forces to be applied along robot arm 300 and/or thesurgical instrument coupled thereto and applying impedances atrespective joints of robot arm 300 to effect the desired forces.

Platform 1400 may incorporate processor 1402, which may consist of oneor more processors and may be a general purpose processor, a digitalsignal processor (DSP), an application specific integrated circuit(ASIC), a field programmable gate array (FPGA) or other programmablelogic device, discrete gate or transistor logic, discrete hardwarecomponents, or any suitable combination thereof designed to perform thefunctions described herein. Platform 1400 also may be implemented as acombination of computing devices, e.g., a combination of a DSP and amicroprocessor, a plurality of microprocessors, one or moremicroprocessors in conjunction with a DSP core, or any other suchconfiguration.

Platform 1400, in conjunction with firmware/software stored in thememory may execute an operating system (e.g., operating system 1446),such as, for example, Windows, Mac OS, QNX, Unix or Solaris 5.10.Platform 1400 also executes software applications stored in the memory.For example, the software may be programs in any suitable programminglanguage known to those skilled in the art, including, for example, C++,PHP, or Java.

Communication circuitry 1404 may include circuitry that allows platform1400 to communicate with an image capture devices such as opticalscanner and/or endoscope. Communication circuitry 1404 may be configuredfor wired and/or wireless communication over a network such as theInternet, a telephone network, a Bluetooth network, and/or a WiFinetwork using techniques known in the art. Communication circuitry 1404may be a communication chip known in the art such as a Bluetooth chipand/or a WiFi chip. Communication circuitry 1404 permits platform 1400to transfer information, such as force measurements on the body wall atthe trocar insertion point locally and/or to a remote location such as aserver.

Power supply 1406 may supply alternating current or direct current. Indirect current embodiments, power supply may include a suitable batterysuch as a replaceable battery or rechargeable battery and apparatus mayinclude circuitry for charging the rechargeable battery, and adetachable power cord. Power supply 1406 may be a port to allow platform1400 to be plugged into a conventional wall socket, e.g., via a cordwith an AC to DC power converter and/or a USB port, for poweringcomponents within platform 1400. Power supply 1406 may be operativelycoupled to an emergency switch, such that upon actuation of theemergency switch, power stops being supplied to the components withinplatform 1400 including, for example, the braking mechanism disposed onat least some joints of the plurality of joints of robot arm 300. Forexample, the braking mechanisms may require power to disengage, suchthat without power supplied to the braking mechanisms, the brakingmechanisms engage to prevent movement of robot arm 300 without power.

User interface 1408 may be used to receive inputs from, and/or provideoutputs to, a user. For example, user interface 1408 may include atouchscreen, display, switches, dials, lights, etc. Accordingly, userinterface 1408 may display information such as selected surgicalinstrument identity and force measurements observed during operation ofrobot arm 300. Moreover, user interface 1408 may receive user inputincluding adjustments to the predetermined amount of movement at thehandle of the surgical instrument or the predetermined dwell time periodto cause the robot arm to automatically switch to the passive mode, thepredetermined threshold of force applied at the handle of the surgicalinstrument to cause the robot arm to automatically switch to theco-manipulation mode, a position of the predefined haptic barrier, anidentity of the surgical instrument coupled to the distal end of therobot arm, a vertical height of the robot arm, a horizontal position ofthe robot arm, etc., such that platform 1400 may adjust theinformation/parameters accordingly. In some embodiments, user interface1408 is not present on platform 1400, but is instead provided on aremote, external computing device communicatively connected to platform1400 via communication circuitry 1404.

Memory 1410, which is one example of a non-transitory computer-readablemedium, may be used to store operating system (OS) 1446, surgicalinstrument identification module 1412, surgical instrument calibrationmodule 1414, encoder interface module 1416, robot arm positiondetermination module 1418, trocar position detection module 1420, forcedetection module 1422, impedance calculation module 1424, motorinterface module 1426, optical scanner interface module 1428, gesturedetection module 1430, passive mode determination module 1432,co-manipulation mode determination module 1434, haptic modedetermination module 1436, robotic assist mode determination module1438, fault detection module 1440, indicator interface module 1442, andfatigue detection module 1444. The modules are provided in the form ofcomputer-executable instructions/algorithms that may be executed byprocessor 1402 for performing various operations in accordance with thedisclosure.

For example, during a procedure, the system may continuously run thealgorithms described herein based on the data collected by the system.That data may be collected and/or recorded using any of the componentsand methods disclosed herein, including, e.g., from sensors/encoderswithin the robots, from optical scanning devices in communication withthe other components of the robotic system, and/or from manual inputs byan operator of the system. Accordingly, the algorithms, the data, andthe configuration of the system may enable the user to co-manipulate therobot arms with minimal impact and influence from the weight of therobot arms and/or surgical instruments coupled thereto, force ofgravity, and other forces that traditional robot arms fail to compensatefor. Some of the parameters of the algorithms described herein maycontrol an aspect of the behavior of the system including, e.g.,robustness of detected features, sensitivity to false positives, robotcontrol gains, number of features to track, dead zone radius, etc.

Surgical instrument identification module 1412 may be executed byprocessor 1402 for identifying the surgical instrument coupled to eachof the robot arms, and loading the appropriate calibration file into thecontroller system. For example, the calibration file for each surgicalinstrument may be stored in a database accessible by surgical instrumentidentification module 1412, and may include information associated withthe surgical instrument such as, e.g., instrument type, weight, centerof mass, length, instrument shaft diameter, etc. Accordingly, when theappropriate calibration file is loaded, and the associated surgicalinstrument is coupled to robot arm 300, the system will automaticallyaccount for the mass of the surgical instrument, e.g., compensate forgravity on the surgical instrument, when the surgical instrument isattached to robot arm 300 based on the data in the calibration file,such that robot arm 300 may hold the surgical instrument in positionafter the surgical instrument is coupled to the robot arm and theoperator lets go of the surgical instrument. For example, surgicalinstrument identification module 1412 may identify the surgicalinstrument based on user input via user interface 1408, e.g., theoperator may select the surgical instrument from a database of surgicalinstruments stored in memory 1410.

In some embodiments, surgical instrument identification module 1412 mayautomatically identify the surgical instrument coupled with the roboticarm via the coupler body and the coupler interface using, e.g., an RFIDtransmitter chip and reader or receiver (e.g., placing an RFID stickeror transmitter on the surgical instrument that may transmit informationabout the surgical instrument to a receiver of the system), an nearfield communication (“NFC”) device such as a near field magneticinduction communication device, a barcode and scanner or other opticaldevice, a magnet based communication system, reed switches, a Bluetoothtransmitter, the weight of the instrument and/or data gathered from theoptical scanner and a lookup table, and/or any other features ormechanisms described herein or suitable for identification of thesurgical instrument. As described above, the coupler body may beselected based on the size and shape of the lumen extending therethroughto accommodate and engage with a surgical instrument having a knownelongated shaft diameter. Accordingly, surgical instrumentidentification module 1412 may automatically identify the surgicalinstrument based on the coupler body that is coupled to the surgicalinstrument via the magnetic connection between the coupler body and thecoupler interface.

In some embodiments, surgical instrument identification module 1412 mayidentify the surgical instrument based on data obtained by opticalscanner 1100 via optical scanner interface module 1428 described infurther detail below. For example, the data may include measurement dataassociated with the specific instrument, such that surgical instrumentidentification module 1412 may compare such data with informationcontained within the database to identify the instrument and load theappropriate calibration file into the controller system. Similarly,surgical instrument identification module 1412 may detect if theinstrument is removed and return the calibration parameters to a defaultconfiguration.

Surgical instrument calibration module 1414 may be executed by processor1402 for calibration a surgical instrument, e.g., a surgical instrumentthat does not currently have an associated calibration file in thedatabase stored in memory 1410. Accordingly, surgical instrumentcalibration module 1414 may calculate measurements and specifications ofa surgical instrument when it is coupled to robot arm 300 and the systemis in calibration mode, as described in further detail below with regardto FIG. 16, based on force measurements of robot arm 300 applied by thesurgical instrument via force detection module 1422. For example,surgical instrument calibration module 1414 may generate a calibrationfile for the surgical instrument including information such asinstrument type, weight, center of mass, length, instrument shaftdiameter, a viscosity parameter of the surgical instrument, etc. Atleast some of the surgical instrument information in the calibrationfile may be provided by user input via user interface 1408, e.g., theinstrument type.

If surgical instrument calibration module 1414 determines thatre-calibration results are consistently different from theconfigurations already loaded into the system, surgical instrumentcalibration module 1414 may replace existing information or add to itslist of known tools without any user inputs and load them automatically.Surgical instrument calibration module 1414 may determine that thecalibration factors are not adequate to compensate for the force ofgravity if, e.g., when a surgical instrument is coupled with the robotarm, the robot arm moves due only to forces of gravity acting on therobot arm and/or the surgical instrument, which may be done when thesurgical instrument is positioned completely outside of the patient'sbody. Moreover, surgical instrument calibration module 1414 mayautomatically update or adjust the calibration factors (e.g., the forcesapplied to the joints of the robot arm) if it determines that thecalibration factors are not adequate to compensate for the force ofgravity. Thus, surgical instrument calibration module 1414 may updatethe calibration factors for the particular surgical instrument and storethe updated calibration factors for the particular surgical instrumentin the associated calibration file for future use.

Encoder interface module 1416 may be executed by processor 1402 forreceiving and processing angulation measurement data from the pluralityof encoders of robot arm 300, e.g., encoders E1-E7, in real time. Forexample, encoder interface module 1416 may calculate the change inangulation over time of the links of robot arm 300 rotatably coupled toa given joint associated with the encoder. As described above, thesystem may include redundant encoders at each joint of robot arm 300, tothereby ensure safe operation of robot arm 300. Moreover, additionalencoders may be disposed on platform 100 to measure angulation/positionof each robot arm relative to platform 100, e.g., the vertical andhorizontal position of the robot arms relative to platform 100.Accordingly, an encoder may be disposed on platform 100 to measuremovement of the robot arms along the vertical axis of platform 100 andanother encoder may be disposed on platform 100 to measure movement ofthe robot arms along the horizontal axis of platform 100.

Robot arm position determination module 1418 may be executed byprocessor 1402 for determining the position of robot arm 300 and thesurgical instrument attached thereto, if any, in 3D space in real timebased on the angulation measurement data generated by encoder interfacemodule 1416. For example, robot arm position determination module 1418may determine the position of various links and joints of robot arm 300as well as positions along the surgical instrument coupled to robot arm300. Based on the position data of robot arm 300 and/or the surgicalinstrument, robot arm position determination module 1418 may calculatethe velocity and/or acceleration of movement of robot arm 300 and thesurgical instrument attached thereto in real time.

Trocar position detection module 1420 may be executed by processor 1402for determining the position and/or orientation of one or more trocarport inserted within the patient. The position and/or orientation of atrocar port may be derived based on data obtained from, e.g., inertialmeasurement units and/or accelerometers, optical scanners,electromechanical tracking instruments, linear encoders, the sensors anddata as described above. For example, the position of the trocar portson the patient may be determined using a laser pointing system that maybe mounted on one or more of the components of the system, e.g., wristportion 311 of the robot arm, and may be controlled by the system topoint to the optimal or determined position on the patient's body toinsert the trocar. Moreover, upon insertion of the surgical instrumentthat is attached to robot arm 300 through a trocar, virtual lines maycontinuously be established along the longitudinal axis of the surgicalinstrument, the alignment/orientation of which may be automaticallydetermined upon attachment of the surgical instrument to couplerinterface 400 via the coupler body via the magnetic connection asdescribed above, in real time as the surgical instrument moves about thetrocar point. Moreover, when the surgical instrument is inserted withinthe trocar port, it will be pointing toward the trocar point, andaccordingly, distal wrist link 316 will also point toward the trocarpoint, the angle of which may be measured by an encoder associatedtherewith. Accordingly, the trocar point may be calculated as theintersection of the plurality of virtual lines continuously establishedalong the longitudinal axis of the surgical instrument. In this manner,the calculated trocar point will remained fixed relative to the patientas the surgical instrument is maneuvered about the trocar port, e.g.,rotated or moved in or out of the patient.

Based on the known position and/or orientation of a trocar port inaddition to the known position of the distal end of robot arm 300 fromrobot arm position determination module 1418, the system may maintainthe position of the distal end of robot arm 300 relative to the trocarpoint as robot arm 300 moves, e.g., via vertical or horizontaladjustment thereof by platform 100, or as the patient table height isadjusted, thereby causing the height of the patient's abdomen to move,thereby keeping the surgical instrument within the patient's body andcoupled to robot arm 300 steady during these external movements. Toachieve this, the known position of the distal end of robot arm 300 fromrobot arm position determination module 1418 is calculated in the globalframe of the system by adding position of platform 100 to the kinematicscalculations (e.g., the “forward kinematics” of robot arm 300 in thecontext of serial chain robotic manipulators). With the position of thedistal end of robot arm 300 known globally, the system may hold thatposition steady by applying appropriate forces to robot arm 300 duringthe external movements that minimize the error between its current anddesired positions.

Force detection module 1422 may be executed by processor 1402 fordetecting forces applied on robot arm 300, e.g., at the joints or linksof robot arm 300 or along the surgical instrument, as well as applied onthe trocar, e.g., body wall forces. For example, force detection module1422 may receive motor current measurements in real time at each motor,e.g., M1, M2, M3, disposed within the base of robot arm 300, which areeach operatively coupled to a joint of robot arm 300, e.g., base joint303, shoulder joint 318, elbow joint 322, wrist joint 332. The motorcurrent measurements are indicative of the amount of force applied tothe associated joint. Accordingly, the force applied to each joint ofrobot arm 300 as well as to the surgical instrument attached thereto maybe calculated based on the motor current measurements and the positiondata generated by robot arm position determination module 1418 and/ortrocar position detection module 1420.

Due to the passive axes at the distal end of robot arm 300, the forceapplied by the instrument coupled with the robot arm on the trocar mayremain generally consistent throughout the workspace of the robot arm.The force on the trocar may be affected by the interaction of the distaltip of the instrument with tissue within the body. For example, if atissue retractor advanced through the trocar is engaged with (e.g.,grasping) bodily tissue or another object inside the body, the forceexerted on the end of the instrument from the bodily tissue or otherobject may cause a change in the force applied to the trocar. In someaspects, the force on the trocar may be a function of how much weight isbeing lifted by the instrument being used.

Impedance calculation module 1424 may be executed by processor 1402 fordetermining the amount of impedance/torque needed to be applied torespective joints of robot arm 300 to achieve the desired effect, e.g.,holding robot arm 300 in a static position in the passive mode,permitting robot arm 300 to move freely while compensating for gravityof robot arm and the surgical instrument attached thereto in theco-manipulation mode, applying increased impedance to robot arm 300 whenrobot arm 300 and/or the surgical instrument attached thereto is withina predefined virtual haptic barrier in the haptic mode, etc. Forexample, by determining the forces applied on robot arm 300 via forcedetection module 1422, as well as the position/velocity/acceleration ofthe distal end of robot arm 300 in 3D space via robot arm positiondetermination module 1418, the desired force/impedance to be applied torobot arm 300 to compensate for the applied forces may be calculated,e.g., for gravity compensation or to hold robot arm 300 in a staticposition in the passive mode. Accordingly, the desired force may beconverted to torque to be applied at the joints of robot arm 300, e.g.,by the motors operatively coupled to the joints of robot arm 300. Forexample, the robot Jacobian may be used for this purpose. Jacobian is amatrix that is computer at each given post of the robot arm, and relatesthe velocities at the joints to the velocity at the distal end of robotarm 300:

V=J*q _(dot)

Here, V is the velocity vector at the distal end of robot arm 300, J isits Jacobian matrix, and q_(dot) is its joint velocities expressed invector form. Using the energy principle, and assuming negligible massesfor the links of robot arm 300 and negligible friction/dampening, thepower of the system may be determined by multiplying its force andvelocity:

F·V=τ·q _(dot)

=>

F·(J*q _(dot))=τ·q _(dot)

Here, F is the generalized force vector at the distal end of robot 300.Further, vector manipulation results in:

(J ^(t) *F)·q _(dot) =τ·q _(dot)

=>

τ=J ^(t) *F

Here, t denotes the transpose of the matrix, such that the forces at thedistal end of robot arm 300 may be converted to torques to be applied atthe joints using the Jacobian matrix.

Motor interface module 1426 may be executed by processor 1402 forreceiving motor current readings at each motor, e.g., M1, M2. M3,disposed within the base of robot arm 300, and for actuating therespective motors, e.g., by applying a predetermined impedance toachieved the desired outcome as described herein and/or to cause thejoints operatively coupled to the respective motors to move, such as inthe robotic assist mode.

Optical scanner interface module 1428 may be executed by processor 1402for receiving depth data obtained by optical scanner 1100 and processingthe depth data to detect, e.g., predefined conditions therein. Moreover,optical scanner interface module 1428 may generate depth maps indicativeof the received depth data, which may be displayed to the operator,e.g., via a monitor. For example, optical scanner interface module 1428may map the location of the trocar ports in 3D space, such that themapping of trocar ports may be communicated to the operator, e.g., viadisplay or user interface 1408. Optical scanner interface module 1428further may receive image data from additional optical scanning devicesas defined herein, including for example, an endoscope operativelycoupled to the system.

Gesture detection module 1430 may be executed by processor 1402 fordetecting predefined gestural patterns as user input, and executing anaction associated with the user input. The predefined gestural patternsmay include, for example, movement of a surgical instrument (whether ornot attached to robot arm 300), movement of robot arm 300 or othercomponents of the system, e.g., foot pedal, buttons, etc., and/ormovement of the operator in a predefined pattern. For example, movementof the surgical instrument back and forth in a first direction (e.g.,left/right, up/down, forward/backward, in a circle) may be associatedwith a first user input requiring a first action by the system and/orback and forth in a second direction (e.g., left/right, up/down,forward/backward, in a circle) that is different than the firstdirection may be associated with a second user input requiring a secondaction by the system. Similarly, pressing the foot pedal or a buttonoperatively coupled with the system in a predefined manner may beassociated with a third user input requiring a third action by thesystem, and movement of the operator's head back and forth or up anddown repeatedly may be associated with a fourth user input requiring afourth action by the system. Various predefined gestural patternsassociated with different components or operators of the system may beredundant such that the associated user input may be the same fordifferent gestural patterns. The predefined gestural patterns may bedetected by, e.g., an optical scanning device such as a laparoscope oroptical scanner 1100 via optical scanner interface module 1428 ordirectly by force applied to robot arm 300 via force detection module1422 or other components of the system.

Actions responsive to user input associated with predefined gesturalpatterns may include, for example, enabling tool tracking to servo(i.e., move) the laparoscope based on the motion of a handheld tool;engaging the brakes on (e.g., preventing further movement of) the robotarm; engaging a software lock on the robot arm; dynamically changing thelength of time that the robot arm takes to transition between statesfrom a default setting; and/or identifying which member of the surgicalstaff is touching the robot arm, if any. This information may be used toensure that the system does not move if the surgeon is not touching therobot arm, e.g., to avoid the scenario where an external force is actingon the robot arm (e.g., a light cable or other wire being pulled acrossthe robot arm) and the system perceives the force to be intentional fromthe surgeon. The same information may be used to detect the gazedirection of the surgeon, e.g., whether the surgeon is looking at thevideo feed or somewhere else in the room, such that the system mayfreeze the robot arm if the surgeon's gaze is not in the direction itshould be. Additionally, the system may reposition a field of view of acamera based on, for example, the direction a surgeon is facing or basedon the objects that the surgeon appears to be looking at, based on thedata from the optical scanner 1100.

In some embodiments, the operator may actively switch the system to acommand mode, e.g., via user interface 1408, where particular movementsor gestures of the robot arm, surgical instrument, operator, orotherwise as described herein are monitored by gesture detection module1430 to determine if they are consistent with a predefined gesturalpattern associated with a predefined user input.

Passive mode determination module 1432 may be executed by processor 1402for analyzing the operating characteristics of robot arm 300 todetermine whether to switch the operational mode of robot arm 300 to thepassive mode where the system applies impedance to the joints of robotarm 300 via motor interface module 1426 in an amount sufficient tomaintain robot arm 300, and accordingly a surgical instrument attachedthereto, if any, in a static position, thereby compensating for mass ofrobot arm 300 and the surgical instrument, and any other external forcesacting of robot arm 300 and/or the surgical instrument. If robot arm 300is moved slightly while in the passive mode, but not with enough forceto switch out of the passive mode, the system may adjust the amount ofimpedance applied the robot arm 300 to maintain the static position, andcontinuous this process until robot arm 300 is held in a staticposition. For example, passive mode determination module 1432 maydetermine to switch the operational mode of robot arm 300 to the passivemode if movement of the robot arm due to movement at the handle of thesurgical instrument as determined by force detection module 1422 is lessthan a predetermined amount, e.g., no more than 1 to 5 mm, for at leasta predetermined dwell time period associated with robot arm 300. Thepredetermined dwell time period refers to the length of time that robotarm 300 and/or the surgical instrument attached thereto, if any, areheld in a static position. For example, the predetermined dwell time mayrange between, e.g., 0.1 to 3 seconds or more, and may be adjusted bythe operator. FIG. 19 illustrates a table or exemplary values of thethreshold dwell times for a range of sample instrument types.

In some embodiments, passive mode determination module 1432 maydetermine to switch the operational mode of robot arm 300 to the passivemode if movement of the robot arm due to movement at the handle of thesurgical instrument as determined by force detection module 1422 has avelocity that is less than a predetermined dwell velocity/speed. Forexample, if passive mode determination module 1432 determines that robotarm 300 and/or the surgical instrument attached thereto, if any, movesat a speed that is lower than the predetermined dwell speed during anentire predetermined dwell period, then passive mode determinationmodule 1432 may switch the operational mode of robot arm 300 to thepassive mode. FIG. 19 illustrates a table or exemplary values of thethreshold dwell speeds for a range of sample instrument types. Forexample, for surgical instruments such as scopes and tissue manipulationdevices, the threshold dwell speeds may be, e.g., 3-5 mm/second, and forsurgical instruments such as suturing instruments, needle drivers, highforce instruments, staplers, and clip appliers, the threshold dwellspeeds may be, e.g., 1-2 mm/second. In some embodiments, passive modedetermination module 1432 may determine to switch the operational modeof robot arm 300 to the passive mode based on the identity of thesurgical instrument upon attachment of the surgical instrument to robotarm 300 and/or responsive detachment of the surgical instrument fromrobot arm 300.

Co-manipulation mode determination module 1434 may be executed byprocessor 1402 for analyzing the operating characteristics of robot arm300 to determine whether to switch the operational mode of robot arm 300to the co-manipulation mode where robot arm 300 is permitted to befreely moveable responsive to movement at the handle of the surgicalinstrument for performing laparoscopic surgery using the surgicalinstrument, while the system applies an impedance to robot arm 300 viamotor interface module 1426 in an amount sufficient to account for massof the surgical instrument and robot arm 300. Moreover, the impedanceapplied to robot arm 300 may provide a predetermined level of viscosityperceivable by the operator. FIG. 19 illustrates a table or exemplaryvalues of viscosity levels for a range of sample instrument types. Insome embodiments, the viscosity level may be a function of the speedthat the surgical instrument is being moved and the distance of the tipof the instrument from the trocar point. For example, co-manipulationmode determination module 1434 may determine to switch the operationalmode of robot arm 300 to the co-manipulation mode if force applied atrobot arm 300 due to force applied at the handle of the surgicalinstrument exceeds a predetermined threshold associated with robot arm300 (e.g., a “breakaway force”). The predefined force threshold may be,e.g., at least 7 Newtons, approximately 7 Newtons, at least 7 Newtons,4-15 Newtons, 4-10 Newtons. The predefined force threshold may bedependent on the type of surgical instrument that is being used and/orwhether there is an external force being applied to the surgicalinstrument.

FIG. 19 illustrates a table or exemplary values of the predefined forcethresholds for a range of sample instrument types. As shown in FIG. 19,the predefined force thresholds may reflect the typical external tissueforces that may be exerted on the surgical instrument. In someembodiments, predefined force threshold may be increased if a force isexerted on the surgical instrument by tissue or an organ or otherwise,depending on the direction of the breakaway force. For example, if thebreakaway force is in the same direction as the force exerted on thesurgical instrument from the tissue or organ, the predefined forcethreshold may be increased by an amount equal to or commensurate withthe force exerted on the surgical instrument from the tissue or organ.In some embodiments, the predefined force threshold for a respectiverobot arm be adjusted based on a patient's body mass index (“BMI”). Forexample, a patient with a higher BMI may have a heavier liver that wouldlikely exert a greater force on the instrument. Accordingly, thepredefined force threshold may selected to be higher for the patientswith a higher BMI. Accordingly, the operation may actuate a “high forcemode,” e.g., via user interface 1408, where predefined force thresholdis increased to accommodate for engaging with heavier tissue or organs.For example, the predefined force threshold may be selectively increasedby 20-100% or more.

Moreover, the force exerted by the user on the surgical instrument andany external tissue forces applied to the surgical instrument may bedirectionally dependent. For example, if the force exerted by the useron the surgical instrument is in the same direction as an externaltissue force applied to the surgical instrument, the two forces may beadditive such that the amount of force exerted by the user on thesurgical instrument needed to overcome the predefined force thresholdmay be reduced by the magnitude of the external tissue force such that alower force than the predefined force threshold would be required toexit the passive mode and enter the co-manipulation mode. On the otherhand, if the force exerted by the user on the surgical instrument is ina direction opposite to an external tissue force applied to the surgicalinstrument, than the necessary amount of force exerted by the user onthe surgical instrument needed to overcome the predefined forcethreshold may be increased by the magnitude of the external tissue forcesuch that a higher force than the predefined force threshold would berequired to exit the passive mode and enter the co-manipulation mode.

In addition, if the force exerted by the user on the surgical instrumentis in a direction that is perpendicular to an external tissue forceapplied to the surgical instrument, than the necessary amount of forceexerted by the user on the surgical instrument needed to overcome thepredefined force threshold may not be affected by the magnitude of theexternal tissue force such that the necessary force exerted by the useron the surgical instrument needed to exit the passive mode and enter theco-manipulation mode will equal the predefined force threshold. Forother directions, the force vectors of the applied forces may be addedto or offset by the force vectors of the external tissue forces toovercome predefined force threshold values for the system or theparticular surgical instrument that is coupled with the robot arm,depending on the direction of the external tissue force, if any, and theforce applied by the user. In some embodiments, co-manipulation modedetermination module 1434 may determine to switch the operational modeof robot arm 300 to the co-manipulation mode based on the identity ofthe surgical instrument.

Haptic mode determination module 1436 may be executed by processor 1402for analyzing the operating characteristics of robot arm 300 todetermine whether to switch the operational mode of robot arm 300 to thehaptic mode where the system applies an impedance to robot arm 300 viamotor interface module 1426 in an amount higher than applied in theco-manipulation mode, thereby making movement of robot arm 300responsive to movement at the handle of the surgical instrument moreviscous in the co-manipulation mode. For example, haptic modedetermination module 1436 may determine to switch the operational modeof robot arm 300 to the haptic mode if at least a portion of robot arm300 and/or the surgical instrument attached thereto is within apredefined virtual haptic boundary. Specifically, a virtual hapticboundary may be established by the system, such that the robot arm orthe surgical instrument coupled thereto should not breach the boundary.For example, a virtual boundary may be established at the surface of thepatient to prevent any portion of the robot arms or the instrumentssupported by the robot arms from contacting the patient, except throughthe one or more trocars. Similarly, the virtual haptic boundary mayinclude a haptic funnel to help guide the instrument into the patient asthe operator inserts the instrument into a trocar port. Accordingly,based on position data of robot arm 300 and/or the surgical instrumentcoupled thereto, e.g., received by robot arm position determinationmodule 1418 and/or trocar position detection module 1420, haptic modedetermination module 1436 may determine if robot arm 300 and/or thesurgical instrument is within the predefined virtual haptic boundary,and accordingly transition robot arm 300 to the haptic mode whereprocessor 1402 may instruct associated motors to apply an effectiveamount of impedance to the joints of robot arm 300 perceivable by theoperator to communicate to the operator the virtual haptic boundary.Accordingly, the viscosity of robot arm 300 observed by the operatorwill be much higher than in co-manipulation mode. In some embodiments,haptic mode determination module 1436 may determine to switch theoperational mode of robot arm 300 to the haptic mode based on theidentity of the surgical instrument.

Robotic assist mode determination module 1438 may be executed byprocessor 1402 for analyzing the operating characteristics of robot arm300 to determine whether to switch the operational mode of robot arm 300to the robotic assist mode where processor 1402 may instruct associatedmotors via motor interface module 1426 to cause movement ofcorresponding link and joints of robot arm 300 to achieve a desiredoutcome. For example, robotic assist mode determination module 1438 maydetermine to switch the operational mode of robot arm 300 to the roboticassist mode if a predefined condition exists based on data obtainedfrom, e.g., optical scanner interface module 1428.

For example, robotic assist mode determination module 1438 may determinethat a condition exists, e.g., the field of view of a laparoscopecoupled to robot arm 300 or optical scanner 1100 is not optimal for agiven surgical procedure, e.g., due to blocking by the surgeon orassistant or another component of the system, based on image dataobtained from the laparoscope or optical scanner 1100 via opticalscanner interface module 1428, such that the robot arm coupled to thelaparoscope or optical scanner 1100 should be repositioned or zoomin/out to optimize the field of view of the surgical site for theoperator. Thus, in robotic assist mode, processor 1402 may instructrobot arm 300, either automatically/quasi-automatically or responsive touser input by the operator, to move to reposition the laparoscope and/orcause the laparoscope to zoom in or zoom out, or to increase aresolution of an image, or otherwise. For example, the user input by theoperator may be determined by gesture detection module 1430, asdescribed above, such that movement of the robot arm or a surgicalinstrument in a predefined gestural pattern in a first direction causesthe endoscope to increase resolution or magnification and in a seconddirection causes the endoscope to decrease resolution or magnification,and movement in another predefined gestural pattern causes the robot armholding the laparoscope to retract away from the patient's body.

In addition, robotic assist mode determination module 1438 may determinethat a condition exists, e.g., that one or more trocars are not in anoptimal position, for example, due to movement of the patient, such thatrobot arm 300 should be repositioned to maintain the trocar in theoptimal position, e.g., in an approximate center of the movement rangeof robot arm 300, thereby minimizing the risk of reaching a joint limitof the robot arm during a procedure. Thus, in robotic assist mode,processor 1402 may instruct system to reposition robot arm 300, e.g.,via vertical/horizontal adjustment by platform 100 or via the joints andlinks of robot arm 300, to better align the surgical instrumentworkspace.

Robotic assist mode determination module 1438 may determine that acondition exists, e.g., the distance between an object and robot arm 300is within a predetermined threshold, based on image data obtained fromthe laparoscope or optical scanner 1100 via optical scanner interfacemodule 1428, such that the robot arm should be frozen to avoid collisionwith the object. Thus, in robotic assist mode, processor 1402 mayinstruct robot arm 300 apply the brakes to slow down the robot arm orinhibit or prevent movement within a predetermined distance from theother object.

Fault detection module 1440 may be executed by processor 1402 foranalyzing the data indicative of the operating characteristics of thesystem, e.g. position data generated by robot arm position determinationmodule 1418 and/or trocar position detection module 1420 and/or forcemeasurement calculated by force detection module 1422, to detect whethera fault condition is present. For example, fault detection module 1440may a fault condition of the system and determine whether the faultcondition is a “minor fault,” a “maj or fault,” or a “critical fault,”wherein each category of fault condition may be cleared in a differentpredefined manner.

For example, fault detection module 1440 may detect a minor faultcondition such as robot arm 300 being moved with a velocity exceeding apredetermined velocity threshold, which may be cleared, e.g., by slowingdown the movement of robot arm 300. In some embodiments, the system mayautomatically apply additional impedance to robot arm 300 when robot arm300 is moving too fast to thereby force the operator to slow downmovement of robot arm 300. Moreover, fault detection module 1440 maydetect a major fault condition such as an inadvertent bump of robot arm300 as indicated by a large force applied to robot arm 300 by a personother than the operator. In response to detection of a major faultcondition, fault detection module 1440 may actuate the braking mechanismassociate with each motorized joint of robot arm 300 (or at least thejoints associated with the major fault condition), to thereby freezerobot arm 300 and inhibit further movement of robot arm 300. Such amajor fault condition may be cleared by the operator actuating a “clear”option displayed on user interface 1408. Fault detection module 1440 maydetect a critical fault condition such as redundant encoders associatedwith a given joint of robot arm 300 generating different angulationmeasurements with a delta exceeding a predetermined threshold. Inresponse to detection of a critical fault condition, fault detectionmodule 1440 may actuate the braking mechanism associate with eachmotorized joint of robot arm 300 to thereby freeze robot arm 300 andinhibit further movement of robot arm 300. Such a critical faultcondition may be cleared by the operator restarting the system. Uponrestart of the system, if the critical fault condition is still detectedby fault detection module 1440, robot arm 300 will remain frozen untilthe critical fault condition is cleared.

Indicator interface module 1442 may be executed by processor 1402 forcausing indicators 334 to communicate the state of the system, e.g., theoperational mode of robot arm 300, to the operator or other users, basedon, for example, determinations made by passive mode determinationmodule 1432, co-manipulation mode determination module 1434, haptic modedetermination module 1436, and/or robotic assist mode determinationmodule 1438. For example, indicator interface module 1442 may causeindicators 334 to illuminate in specific color light associated with aspecific state of the system. For example, indicator interface module1442 may cause indicators 334 to illuminate in a first color (e.g.,yellow) to indicate that no surgical instrument is attached to the robotarm, and that the robot arm may be moved freely such that the systemcompensates for the mass of the robot arm; in a second color (e.g.,purple) to indicate that a surgical tool is attached to the robot arm,and that the robot arm may be moved freely such that the systemcompensates for the mass of the robot arm and the mass of the surgicalinstrument coupled to the robot arm; in a third color (e.g., blue) toindicate that a surgical instrument is attached to the robot arm, andthat the robot arm is in the passive mode as determined by passive modedetermination module 1432; in a fourth color (e.g., pulsing orange) toindicate that at least a portion of the robot arm and/or the surgicalinstrument attached thereto is within the virtual haptic boundary, e.g.,1.4 m or more above the ground; in a fifth color (e.g., pulsing red) toindicate that a fault has been detected by the system by fault detectionmodule 1440. As will be understood by a person having ordinary skill inthe art, different colors and patterns may be communicated by indicators334 to indicate the states of the system described above.

Additionally, indicators 334 may be illuminated in other distinct colorsand/or patterns to communicate additional maneuvers by robot arm 300,e.g., when robot arm 300 retracts the surgical arm in the robotic assistmode, or performs another robotically-assisted maneuver in the roboticassist mode. As described above, indicators 334 further may includedevices for emitting other alerts such as an audible alert or textalert. Accordingly, indicator interface module 1442 may cause indicators334 to communicate the state of the system to the operator using audioor text, as well as or instead of light.

Fatigue detection module 1444 may be executed by processor 1402 fordetecting user fatigue that may occur during operation of robot arm 300in a surgical procedure, as described in further detail below withregard to FIG. 25. For example, based on data from, e.g., robot armposition determination module 1418, force detection module 1422,impedance calculation module 1424, fatigue detection module 1444 maydetermine the level of fatigue of the operator using the surgicalinstrument coupled to robot arm 300, and compare the level of fatiguewith a predetermined fatigue threshold. For example, fatigue detectionmodule 1444 may assess an overall score for a given procedure todetermine the level of fatigue based on, e.g., operator hand tremor,distance/minimum path travelled by the instrument tip, time to achieveprocedure steps, and/or time to complete the procedure. Based on thedata generated by fatigue detection module 1444, impedance calculationmodule 1422 may determine an amount of impedance necessary to apply torobot arm 300 to, e.g., reduce tremor of the operator, such that motorinterface module 1426 may cause the associated motors to apply therequisite impedance to robot arm 300. Moreover, based on the datagenerated by fatigue detection module 1444, motor interface module 1426may cause the associated motors to move the links of robot arm 300 toguide the operator's manipulation of the surgical instrument attachedthereto.

The co-manipulation surgical robot systems described herein may includeadditional modules within memory 1410 of platform 200 for executingadditional tasks based on the data obtained. For example, the system maydetermine that a surgical instrument has been attached to robot arm 300by detecting a rapid or sudden change in force (a “snapping motion”)applied to robot, e.g., due to the attraction force of the magneticconnection between the coupler body and coupler interface 400, via forcedetection module 1422. For example, the attractive forces of the magnetson the coupler body and coupler interface 400 may cause a suddenmovement on at least an end portion of the robot arm, and/or a suddenrotation of the last joint of the robot arm when the magnets arealigning. Accordingly, this sudden movement may be detected and maytrigger surgical instrument identification module 1412 to determine thatan instrument has been attached or detached from the robot arm.Similarly, surgical instrument identification module 1412 may determinethat the surgical instrument has been detached from robot arm 300, e.g.,when subsequent motions of the distal end of robot arm 300 areaccompanied by little to no rotation in the distal-most joint of robotarm 300.

Additionally, the system may determine if the surgical instrument hasbeen detached from robot arm 300 based on data indicative of theposition of the distal end of robot arm 300 relative to the trocar pointgenerated by trocar position detection module 1420, as well as thedirection of an instrument shaft and/or an orientation of thedistal-most link of robot arm 300, e.g., distal wrist link 316. Forexample, if the instrument is pointing directly at the trocar, thenthere is a higher probability that a tool is attached to the robot arm.Moreover, axis Q7 of robot arm 300 may indicate the pointing directionof the instrument and, if the instrument is passing through the trocarport, the distal wrist link 316 will point in a direction of the trocarport. Therefore, if distal wrist link 316 is not pointing toward thetrocar port, then the system may determine that the robot arm is notsupporting an instrument or the instrument is not advanced through thetrocar port. For example, when an instrument is detached from robot arm300 and robot arm 300 is moved, the computed direction of the instrumentshaft (e.g., the direction that the instrument would point if attachedto robot arm 300) may no longer point to the trocar entry point andlikely will not point to the trocar entry point. Accordingly, the mayalert a user if the system determines that no tool is coupled with robotarm 300, e.g., via indicators 334.

In addition, the system may identify when a user may be attempting toremove or decouple a surgical instrument from robot arm 300 and adjustthe removal force required to decouple the surgical instrument, andaccordingly the coupler body, from coupler interface 400. For example,where one or more magnets are used to provide a biasing force to biasthe surgical coupler body to the coupler interface, a force greater thanthe attraction force provided by the one or more magnets in a directionopposing the force provided by the one or more magnets must be exertedon the surgical instrument and/or the coupler body that is coupled withthe surgical instrument to overcome the attracting force and decouplethe coupler body and surgical instrument from the coupler interface. Forexample, the removal force may be 30-60 Newtons.

Moreover, the system may gather and analyze telemetry data regardingforces being applied to the robot arm to assess or estimate whether auser is attempting to remove a tool from the robot arm and, if so,reduce the coupling force between the coupler body and the couplerinterface to make it easier for the user to disengage the surgicalinstrument from the robot arm. For example, the coupling/removal forcemay be reduced by 50-80%. Based on historical data and user feedback, aswell as on data such as whether a user replaces the instrument withoutadjusting a location of the instrument, which could indicate inadvertentremoval of the instrument, the system may estimate the optimal times toreduce a coupling force between the coupler body and the couplerinterface. Moreover, the coupling force may be increased duringoperation to prevent inadvertent removal of surgical instrument from therobot arm.

Additionally, the system may determine an optimum positioning of robotarms 300 and its joints, the surgical instruments coupled with the robotarms, or other components of the robot arms and/or the system based ondata obtained from the optical scanning devices used with the system,and provide guidance to the operator of the system to achieve theoptimum positioning. Data indicative of the optimum positioning furthermay be used by processor 1402 to instruct the motors to causecorresponding links and joints of robot arm 300 to move, e.g., inrobotic assist mode, to automatically reposition robot arm 300 and/orthe optical scanning devices in the optimum position, e.g., during thesetup stage or thereafter.

In addition, the system may collect data from sensors, e.g., positiondata of robot arm 300 or the surgical instrument attached thereto viathe encoders or optical scanning devices and/or position data of theoperator via body sensors or optical scanning devices, during aprocedure, e.g., during setup or operation of robot arm 300, such thatprocessor 1402 may detect deviations of movements or processes of thecurrent user as compared to a model or optimal movement pattern, andcommunicate the deviations to the current user in real-time. Forexample, processor 1402 may cause a monitor to display the deviations tothe current user in real-time, as well as the optimal and/or actualmovement pattern. Additionally, or alternatively, indicator interfacemodule 1440 may cause indicators 334 to indicate deviations from themodel or optimal movement pattern, e.g., by illuminating a specificcolor and/or in a specific pattern. Additionally, or alternatively,motor interface module 1426 may apply impedance to robot arm 30perceivable by the operator as haptic feedback including vibrations,restrictions on movement, or sensations to indicate deviations from themodel or optimal movement pattern. Accordingly, the system may be usedas a training tool for new users as such data may be used to optimizethe position of a surgical device in real-time.

The system further may analyze the depth map generated by the opticalscanning devices and cluster different groups of (depth) pixels intounique objects, a process which is referred to as object segmentation.Examples of such algorithms for segmentation may include: matchingacquired depth map data to a known template of an object to segment;using a combination of depth and RGB color image to identify and isolaterelevant pixels for the object; and/or machine learning algorithmstrained on a real or synthetic dataset to objects to identify andsegment. Examples of such segmentation on a depth map may include:locating the robot arms or determining the position of the robot arms;identifying patient ports (e.g., trocar ports) and determining adistance from the instruments to the trocar ports; identifying thesurgeon and distinguishing the surgeon from other operators in the room;and/or identifying the surgeon in the sensor's field of view. Moreover,the system may use object segmentation algorithms to uniquely identifythe surgeon and track the surgeon with respect to, for example, asurgical table, a patient, one or more robot arms, etc. In addition, thesystem may use object segmentation algorithms to determine if a surgeonis touching or handling either of the robot arms and, if so, identifywhich robot arm is being touched or handled by the surgeon.

Referring now to FIG. 15, operation 1500 of the co-manipulation surgicalrobot systems described herein is provided. As shown in FIG. 15, at step1502, the operator may couple a selected surgical instrument to couplerinterface 400 of robot arm 300 via a coupler body, e.g., coupler body500, 600, 700. As described above, the operator may select a couplerbody sized and shaped to couple with the selected surgical instrument,e.g., based on the elongated shaft diameter of the surgical instrument.When the surgical instrument and coupler body are ready to be coupled torobot arm 300, the operator may load the calibration file of theselected surgical instrument, e.g., via user interface 1408, such thatinformation associated with the selected surgical instrument, e.g., alaparoscope or retractor, is loaded into the system. For example, theoperator may select the calibration file from a database of calibrationfiles for a variety of surgical instruments. The calibration files maybe stored from previous procedures, and may be pre-loaded to includecalibration files of commonly used laparoscopic instruments.

If the calibration file for the selected surgical instrument is notavailable in the database, the operator may self-calibrate the surgicalinstrument using the system. For example, FIG. 16 illustrates surgicalinstrument calibration process 1600 for calibrating a surgicalinstrument, e.g., to determine the center of mass of the surgicalinstrument, which may be used in calculating accurate force measurementson the surgical instrument and robot arm 300 during operation. At step1601, the operator may actuate the “startup” option on user interface1408. At step, 1602, the operator may select the “load tool calibration”to begin the calibration process. At step 1603, the system does notapply any impedance to robot arm 300 for gravity compensation of asurgical instrument. The system may apply impedance to robot arm 300 toaccount for the weight of robot arm 300, e.g., to prevent robot arm 300from dropping to the ground. At step 1604, the surgical instrument iscoupled to coupler interface 400 of robot arm 300 via the appropriatesized coupler body, which may cause wrist portion 411 of robot arm 300to rotate about axis Q7 to engage with the coupler body.

At step 1605, the system compensates for the gravity of the surgicalinstrument and the force applied by the hand of the operator, e.g., bymeasuring the force applied to the distal end of robot arm 300 due tothe mass of the surgical instrument. As described above, the forceapplied to the distal end of robot arm 300 may be measured by measuringthe motor current across the motors disposed in the base of robot arm300. If the system overcompensates for the gravity of the surgicalinstrument, at step 1606, robot arm 300 may “runaway”, e.g., driftupward. The runaway effect may be detected at step 1607, and at step1608, indicators 334 may blink to indicate to the operator of therunaway. At step 1609, the system may identify the runaway as a minorfault, and accordingly apply additional impedance to robot arm 300 andfreeze robot arm 300 when robot arm 300 slows down before removing theadditional impedance. Once the minor fault is addressed, calibrationprocess 1600 may return to step 1603.

After step 1605, when the system compensates for the gravity of thesurgical instrument, if the surgical instrument is detached, eitheraccidentally or manually by the operator at step 1611, at step 1610, thesystem detected the detachment of the surgical instrument from robot arm300. As a result, the system will stop compensating for the gravity ofthe surgical instrument, and calibration process 1600 may return to step1603. After step 1605, when the system compensates for the gravity ofthe surgical instrument, calibration process 1600 is ready to entercalibration mode at step 1612. For example, the operator may initiatecalibration mode via user interface 1408 at step 1613. At step 1614, thesystem may indicate to the operator, e.g., via user interface 1408and/or blinking of indicators 334, that it is safe to let go of surgicalinstrument, such that the operator may let go of the surgical instrumentat step 1616. At step 1615, the system calibrations the surgicalinstrument.

Referring again to FIG. 15, when the surgical instrument and couplerbody are ready to be coupled to robot arm 300, and the appropriatecalibration file is loaded, the operator may easily place the couplerbody near coupler interface 400, such that the magnetic connectionbetween the coupler body and coupler interface 400 automatically alignsand coupled the surgical instrument to robot arm 300. The system willnow accurately compensate for the gravity of the selected surgicalinstrument. At step 1504, the user may use the co-manipulation surgicalsystem by freely manipulating the surgical instrument coupled to robotarm 300 in the ordinary manner that the operator would without robot arm300 coupled thereto. As shown in FIG. 15, as the operator manipulatesthe surgical instrument, and accordingly robot arm 300 coupled thereto,the system may automatically switch between, e.g., co-manipulation mode1506, passive mode 1508, haptic mode 1510, and robotic assist mode 1512(collectively referred to as “operational modes”), upon detection ofpredefined conditions, as described below with regard to FIG. 17. Insome embodiments, the system may automatically switch between onlyco-manipulation mode 1506, passive mode 1508, and haptic mode 1510. Insome embodiments, the operator may select which operational mode to setthe system in prior to using the co-manipulation surgical system at step1504.

For example, an operator may exert a particular force on the distal endof robot arm 300, e.g. by manipulating the surgical instrument coupledto robot arm 300, to indicate that the operator wishes to change theoperational mode of the particular robot arm. Sensors and/or motorcurrent readings may be used to detect the force applied to the distalend of robot arm 300 and to determine if the force matches a predefinedforce signature associated with an operational change, e.g., bycomparing the force with one or more predefined force signatures storedin the system. If there is a match, then the system may change theoperational mode of the robot arm to the particular operational modethat matches the force signature.

As described above, during operation of the co-manipulation surgicalsystem, the system may continuously monitor the robot arm and forcesapplied thereto to detect predefined conditions that require switchingthe operational modes of the system, as described in method 1700 of FIG.17. As shown in FIG. 17, at step 1702, the system continuously collectsdata related to a first operating characteristic of the robot arm and/orof the surgical instrument coupled with the robot arm. For example, asdescribed above, the system may measure motor current of the motorsoperatively coupled to the joints of the robot arm as well asangulations of the links of the robot arm based on measurements by theencoders of the robot arm to calculate the positon of the robot arm andthe surgical instrument as well as the forces acting on any portion ofthe robot arm as well as on the surgical instrument, if any, in realtime. At step 1704, the system may analyze the data related to the firstoperating characteristic to determine if a first condition is present.For example, based on the position and force data of the robot armand/or surgical instrument, the system may determine if the movement ofthe robot arm due to movement of the surgical instrument coupled theretois within a predetermined movement threshold of the robot arm for aperiod of time longer than the predetermined dwell time of the robotarm. Upon detection of this first condition, at step 1706, the systemmay modify a first operating parameter of the robot arm. For example,the system may switch the operational mode of the robot arm to thepassive mode, where the robot arm maintains the surgical instrument in astatic position.

For example, a first robot arm may be coupled to a laparoscope, and theoperator may manipulate the laparoscope within the patient until adesirable field of view is provided by the laparoscope, e.g., via amonitor displaying the image feed from the laparoscope. In order tofreely move the laparoscope coupled to the first robot arm in theco-manipulation mode, the operator must apply a sufficient force to thelaparoscope that exceeds a predetermined force threshold. Thepredetermined force threshold should be low enough such that it does notrequire much force by the operator to freely move the laparoscope.Moreover, the predetermined force threshold may be selected so as toresist inadvertent movement away from the passive mode. As the operatorfreely moves the laparoscope in the co-manipulation mode, as describedabove, the system will apply enough impedance to the first robot arm tocompensate for the effects of mass (i.e., inertia) and/or gravity of thefirst robot arm and the laparoscope during the movement, such that amass or weight of the first robot arm is not detectable by the operatoror is otherwise significantly attenuated. In some embodiments, if whenthe operator couples the laparoscope to the first robot arm, thelaparoscope is not already positioned within the body of the patient,the system may determine that there are no external forces acting on thesurgical instrument and may automatically switch the first robot arm tothe haptic mode in order to guide the operator to move the laparoscopeto the appropriate location through the trocar port, e.g., via a virtualhaptic funnel established about the trocar port.

When the laparoscope is in the desired position relative to the patientand the surgical site within the patient, the system will automaticallyswitch from co-manipulation mode to passive mode upon detection thatmovement of the first robot arm due to movement of the surgicalinstrument is within a predetermined movement threshold for a period oftime exceeding a predetermined dwell time. For example, upon reachingthe desired position, the operator will hold the laparoscope in thedesired position, e.g., for at least a quarter of the second. Thus, ifthe predetermined dwell time is a quarter of a second, holding thelaparoscope in the desired position for any longer than thepredetermined dwell period will cause the system to automatically switchto passive mode. Moreover, as the operator may not be able to hold thelaparoscope perfectly still, at least some movement of the laparoscopeis permitted for the duration of the predetermined dwell time to enterinto the passive mode. As described above, in passive mode, the firstrobot arm will hold the laparoscope in a static position, e.g., by thesystem applying enough impedance to the first robot arm to compensatefor all external forces acting on the laparoscope.

Similarly, a second robot arm may be coupled to a retractor, and theoperator may freely manipulate the retractor within the patient in theco-manipulation mode, e.g., to grasp tissue within the patient andretract the tissue to provide a clear field of view of the surgical siteby the laparoscope coupled to the first robot arm, by applying asufficient force to the second robot arm due to force applied at theretractor exceeding the predetermined force threshold of the secondrobot arm. As the operator grasps/lifts/retracts the tissue withretractor, the system may only compensate for the gravity of the secondrobot arm and/or the instrument and not of the tissue being grasped,such that the operator may feel any other forces acting on theretractor, including without limitation the forces acting on theinstrument from the tissue. In this optional configuration. Accordingly,the haptics associated with the tissue being grasped may be preserved.

When the retractor sufficiently grasps and retracts the tissue, thesystem may automatically transition to the passive mode upon theoperator holding the retractor in position, e.g., with movement notexceeding a predetermined movement threshold of the second robot arm,for a period of time exceeding the predetermined dwell period of thesecond robot arm. Accordingly, when the retractor is retracting thetissue within the patient in the passive mode, the second robot arm willaccount for the mass of the tissue in addition to the mass of theretractor and the second robot arm. Thus, the predetermined forcethreshold to cause the second robot arm to switch out of the passivemode must be greater than the force applied to second robot arm due toforce applied to the tip of the retractor by the tissue, such that ifthe force applied by the tissue to the surgical instrument exceeds thepredetermined first threshold of the second robot arm, the system willautomatically cause the second robot arm to switch out of the passivemode and into, e.g., the co-manipulation mode. However, thepredetermined force threshold should not be so high that it is verydifficult for the operator to move the retractor. As described above,the operator may adjust the predetermined force threshold via, e.g.,user interface 1408.

Upon retraction of the tissue via the retractor coupled to the secondrobot arm, the operator may need to readjust the field of view of thelaparoscope coupled to the first robot arm. Accordingly, the operatormay apply a force to the laparoscope that exceeds the predeterminedforce threshold of the first robot arm, such that the systemautomatically switches the first robot arm from the passive mode to theco-manipulation mode. When the new desired position of the laparoscopeis achieved, the first robot arm may automatically switch back to thepassive mode if the predefined conditions described above are met.Alternatively, to readjust the laparoscope or to reposition the links ofthe first robot arm to avoid potential collisions during thelaparoscopic procedure or to switch the laparoscope to a different robotarm altogether, the operator may elect to decouple the laparoscope,readjust the robot arm and/or laparoscope, and reattach the laparoscopeto the first robot arm (or to the other robot arm). Upon reattachment ofthe laparoscope to the first robot arm, the first robot arm mayautomatically switch to the passive mode if the predefined conditionsdescribed above are met.

Moreover, as the operator freely moves the retractor in theco-manipulation mode, e.g., prior to inserting the tip of the retractorthrough the trocar within the patient, if the operator moves the tip ofthe retractor too close to the patient's skin away from the trocar port,and a virtual haptic boundary has been established by the system on theskin of the patient outside the trocar ports, the system mayautomatically switch to the haptic mode. Accordingly, the system mayapply an impedance to the second robot arm that is much higher than theimpedance applied to the second robot arm in co-manipulation mode toindicate to the operator that they are approaching or within the virtualhaptic boundary. For example, movement of the retractor by the operatormay feel much more viscous in the haptic mode. The system may remain inthe haptic mode until the operator moves the retractor out of thevirtual haptic boundary. In some embodiments, in the haptic mode, thesecond robot arm may reduce the effects of gravity, eliminate tremor ofthe instrument tip, and apply force feedback to avoid criticalstructures as defined by the virtual haptic boundary. Accordingly, thesystem does not replace the operator, but rather augments the operator'scapabilities through features such as gravity compensation, tremorremoval, haptic barriers, force feedback, etc.

In some embodiments, the system may switch the second robot arm to therobotic assist mode. For example, as the operator attempts to retractthe tissue, if more force is required to retract the tissue than theoperator is able or willing to apply to the retractor, the operator mayprovide user input to the system indicating that the operator wants thesecond robot arm to assist in the retraction of the tissue. For example,as described above, the operator may perform a predefined gesturalpattern that may be detected by, e.g., optical scanner 1100, such thatthe system switches the second robot arm to the robotic assist mode andcauses the motors of the second robot arm to move the second robot arm,and accordingly the retractor, to provide the additional force requiredto retract the tissue.

In addition, instead of manually manipulating the laparoscope coupled tothe first robot arm as described, the operator may provide another userinput to the system indicating that the operator wants the system toreposition the laparoscope. For example, if the operator is activelymanipulating a surgical scissor, which may or may not be coupled to arobot arm of the system, such that the tip of the surgical scissor iswithin the field of view of the laparoscope coupled to the first robotarm, the operator may perform a predefined gestural pattern with the tipof the surgical scissor, e.g., moving the surgical scissor quickly backin forth in a particular direction. The predefined gestural pattern ofthe surgical scissor may be captured as image data by the laparoscope,and based on the data, the system may detect and associated thepredefined gestural pattern with a predefined user input requiring thatthe system switch the first robot arm from the passive mode to therobotic assist mode, and cause the first robot arm to reposition itself,and accordingly the laparoscope, to adjust the field of view in thedirection of the pattern motion of the surgical scissor. As describedabove, additional gestural patterns may be performed via the surgicalscissor within the field of view of the laparoscope to cause the firstrobot arm to retract the laparoscope and/or to cause the laparoscopeitself to zoom in or zoom out or improve resolution. In someembodiments, based on the image data captured by the laparoscope, usingobject tracking of the additional tools in the field of view of thelaparoscope, e.g., the surgical scissors actively operated by theoperator, the system may cause the first robot arm coupled to thelaparoscope to automatically switch to the robotic assist mode and causethe first robot arm to reposition itself to adjust the field of view toensure that the tip of the surgical scissors remain within an optimumposition within the field of view of the laparoscope during theprocedure.

The operational mode of any one of the robot arms may be changedindependent of the operational mode of the other robot arms of thesystem. In addition, the operational parameters of each robot arm may betailored to the specific surgical instrument coupled thereto. Forexample, the predetermined force threshold for the robot arm coupled tothe retractor device may be higher than the predetermined forcethreshold for the robot arm coupled to the laparoscope, as the retractorwill endure higher forces during the procedure. The sensors, motors,etc. of the system may be active in all modes, but may act verydifferently in each mode, e.g., including acting as if inactive. As willbe understood by a person having ordinary skill in the art, the systemmay include more than two robot arms, such that the operator may couplea third surgical instrument, e.g., a grasper device, to a third robotarm and a fourth surgical instrument, e.g., a surgical scissor device,to a fourth robot arm for operation during the laparoscopic procedure.

In some embodiments, the operational mode of a robot arm may be changedresponsive to user input provided by the operated. For example, theoperator may selectively change the operational mode of the robot arm byactuating a button, dial, or switch located on the robot arm, a footpedal or foot switch, voice command, an input on a touchscreen, or usinggestures or force signatures as described above. In some embodiments,the operational mode of a robot arm may be changed based only on thecoupling of the surgical instrument to the coupler interface via thecoupler body. As described above, the system may automatically identifythe surgical instrument based on the coupling of the coupler body to thecoupler interface. Accordingly, based on the identity of the surgicalinstrument coupled to the robot arm, the system may automatically switchthe operational mode of the robot arm to a predetermined operationalmode, e.g., passive mode if the surgical instrument is an endoscope, orif the robot arm is already in the passive mode, the system will remainin the passive mode upon coupling of the endoscope with the robot arm.

Similarly, based on the identity of the surgical instrument uponattachment of the surgical instrument to the robot arm, the system mayautomatically switch the operational mode of the robot arm to theco-manipulation mode, e.g., is the surgical instrument identityindicates that it is a tool that will be actively operated by theoperator during the laparoscopic procedure. Additionally, based on theidentity of the surgical instrument upon attachment of the surgicalinstrument to the robot arm, the system may automatically switch theoperational mode of the robot arm to the robotic assist mode, e.g., ifthe surgical instrument identity indicates that it is a tool that theoperate desires to be completely robotically controlled such as anirrigation device. Accordingly, upon attachment of the irrigation deviceto the robot arm, the system will switch to the robotic assist mode andcause the robot arm to position the irrigation device in the desiredposition within the body.

Moreover, the system may be instructed by the operator, e.g., via userinterface 1408, to operate the robot arm in less than the fouroperational modes discussed above. For example, the operator maydeactivate any one of the operational modes for a give procedure. Insome embodiments, the system may cause the robot arm to operate in anadditional operational mode, such as a locking mode, which may besimilar to the passive mode, except that the predetermined forcethreshold of the robot arm to switch out of passive/locking mode may beso high that the robot arm is effectively frozen so as to protect therobot arm from inadvertently switching out of the passive/locking mode,e.g., to avoid movement due to inadvertent bumps of the robot arm. Inthis locking mode, if the force from the inadvertent bump issufficiently high to cause even a slight movement of the robot arm, thesystem may cause the robot arm to reposition itself to the position itwas in prior to the inadvertent bump.

In addition, when no surgical instrument is coupled to the distal end ofa robot arm of the system, the system is still capable of automaticallyswitching the operational modes of the robot arm responsive to movementof the robot arm by an operator upon detection of the predefinedconditions described above. Accordingly, the system will apply animpedance to the joints of the robot arm to compensate for the mass ofthe robot arm such that the robot arm may remain in a static positionwhen in the passive mode, and will permit the robot arm to be freelymoveably by the operator in the co-manipulation mode if the systemdetects that the force applied to the robot arm by the operator exceedsthe predetermined force threshold of the robot arm. Additionally, thesystem will switch the robot arm to the haptic mode if the operatorattempts to move any portion of the robot arm within a predefinedvirtual haptic barrier.

At step 1514, when the laparoscopic procedure is complete, the operatormay remove the surgical instruments from the respective robot arms.

Referring now to FIGS. 18A to 18C, force measurements during operationof robot arm 300 are provided. As described above, upon attachment ofthe surgical instrument to coupler interface 400 via the coupler bodycoupled to the surgical instrument, the orientation of the surgicalinstrument may be automatically determined based on the magneticconnection between the coupler interface and the coupler body. Moreover,as described above, the calibration file of the surgical instrumentcoupled to robot arm 300 loaded on the system may include information ofthe surgical instrument including, e.g., the mass of the surgicalinstrument, the center of mass of the surgical instrument, and thelength of the surgical instrument, such that distance D3 between thecenter of mass and the instrument tip may be derived. In addition, asdescribed above, the position of the surgical instrument at the trocar,e.g., where the surgical instrument enters the patient's body, may becalculated in real-time, such that distance D2 between the center ofmass of the surgical instrument and the trocar may be derived in realtime. Additionally, as described above, the coupler body is preferablycoupled to the surgical instrument at a fixed, known position along theelongated shaft of the surgical instrument (which may be included in thecalibration file), e.g., adjacent to the proximal portion of thesurgical instrument, and thus distance D1 between the center of mass ofthe surgical instrument and the coupler body, e.g., the point ofattachment to the distal end of robot arm 300, may be derived.Alternatively or additionally, as described above, optical scanningdevices may be used determine any one of D1, D2, or D3.

As shown in FIG. 18A, when the surgical instrument is positioned throughtrocar Tr, without any additional external forces acting on the surgicalinstrument other than at trocar Tr, e.g., the surgical instrument is notlifting or retracting tissue within the patient, the force applied tothe surgical instrument at trocar Tr by the body wall (e.g., the “bodywall force” or the “trocar force”) may be calculated with the followingequation:

F _(eff) +W+F _(tr)=0=>F _(tr) =−W−F _(eff)

Where F_(eff) is the force at the distal end of robot arm 300 (e.g., the“end-effector force” of robot arm 300), W is the weight vector of thesurgical instrument (=−mgz), and F_(tr) is the trocar force.Accordingly, F_(eff) is the desired force sent to the system, which isthe sum of all the forces generated in the algorithm pipeline including,e.g., gravity compensation, hold, etc.

As shown in FIG. 18B, when the surgical instrument is positioned throughtrocar Tr and holding/retracting tissue, such that an external force isapplied to the tip of the surgical instrument, there are two forces toresolve: F_(tr) and F_(tt). Accordingly, two equations are needed tosolve for the two unknown vectors, which may be the balances of forcesand also the balance of moments around the center of mass of thesurgical instrument, e.g., L_(cg).

W+F _(eff) +F _(tr) +F _(tt)=0

F _(eff) ×D1+F _(tr) ×D2+F _(tt) ×D3=0

Here, distances D1 and D3 are known as described above, and D2 may bederived based on the known position of the distal end of robot arm 300and the calculated position of trocar Tr. As shown in FIG. 18B, thecenter of mass L_(cg) of the surgical instrument is behind the point ofattachment of the coupler body to the distal end of robot arm 300.

As described above, the system may alert the operator if the forces,e.g., force F_(tt) applied to the tip of the instrument and/or forceF_(tr) applied by the instrument at the trocar using, are greater thanthe respective threshold forces, and accordingly freeze the system ifthe calculated force is greater than the threshold force, and/or reducethe force exerted at the trocar point at the body wall or at the tip ofthe instrument by automatically applying brakes or stopping forces torobot arm 300, by slowing or impeding further movement of the instrumentin the direction that would increase forces applied at the tip of theinstrument or the trocar, and/or automatically moving the robotic arm ina direction that reduces the force being exerted at the instrument tipand/or at the trocar point at the body wall.

Referring now to FIG. 20, a high level example 2000 of the differentcombinations of data inputs for the various sensors and devices of thesystems disclosed herein, e.g., system 200, and the multiple featuresand capabilities that any implementations of the systems disclosedherein may have and can produce based at least in part on the multiplepossible data inputs is provided. As shown in FIG. 20, someimplementations of the system may be configured to gather data from atleast three monitoring sources 2002, including telemetry from the system(which may include force data from the robot arms, position data fromthe robot arms, etc.), video from the laparoscopic tower, and/or datafrom optical scanner 1100. The data gathered from the monitoring sources2002 may undergo data processing steps 2004 using one or more processorsin the system. The data processing steps may include, e.g., data fusion(e.g., fusion of the data gathered from the monitoring sources 2002) anddata analysis, which may include algorithm computations. In addition,the data from the monitoring sources 2002 may undergo processing 2004for the development of system usability features 2006, system safetyfeatures 2008, and system performance features 2010. The system mayprovide the features in real-time. For example, the system usabilityfeatures may include identifying the surgeon and adjusting the platformheight based on the surgeon's profile, detecting the skin surface of thepatient and creating a virtual boundary around the skin surface toprevent inadvertent contact with the skin surface of the patient,detecting an instrument type and automatically loading the calibrationfile appropriate for the particular instrument, etc.

Referring to FIG. 21, a schematic overview of the electrical componentsof the electrical system and connectivity 2100 of the system isprovided. This includes the flow of energy throughout the illustratedportion of the system, the ports that may be used for connectivity, andother details related to the various electronic components. For examplethe system may include non-real time computer 2102 that may be used toacquire data from the optical scanning devices and perform otherfunctions. Non-real time computer 2102 also may control the graphicaluser interface of the system for the surgeon to interact with. Asdescribed above, the graphical user interface may include a touchscreen. Non-real time computer 2102 may include, e.g., a 10th Gen Intel®Core™ i7-10700 processor, 32 GB of RAM (which can optionally be 2×16 GB,DDR4, 2933 Mhz), a standard keyboard and a 512 GB PCIe M.2 SSD +1 TBSATA 7200 RPM hard drive, a wireless and Bluetooth card such as theKiller™ Wi-Fi 6 AX1650i (2×2) 802.11ax Wireless and Bluetooth 5.1,and/or a NVIDIA® GeForce RTX™ 2060 6 GB GDDR6 graphics card. The systemfurther may include real-time computer 2104 that may be used to operateand control the robot arms and the related robot controllers and/orother functions, such as acquiring data and information from the opticalscanning devices. Real-time computer 2104 may include, e.g., an IntelCore i7 (8th Gen) processor, 32 GB of RAM for memory, a 500 GB SDD harddrive, and/or two or more RJ45 connectors for Ethernet connectivity.

Referring now to FIG. 22, a flow chart of process 2200 for theacquisition and processing of data from an optical scanning device isprovided. As shown in FIG. 22, at step 2202, depth data may be acquiredfrom one or more optical scanning devices, e.g., optical scanner 1100.At step 2204, filtering/other signal processing algorithms may beperformed, e.g., median filter, Gaussian noise removal, anti-aliasingalgorithms, morphological operations, ambient light adjustments, etc. Atstep 2206, 3D object segmentation may be performed using, e.g., templatematching, machine learning, Brute force matching, color plus depthsegmentation, 2D-3D registration, pixel value thresholding, etc. At step2208, object coordinates may be transformed to task space. For example,transforming object coordinates to task space may include converting aposition and an orientation of an object from the optical scanningdevice's coordinate frame to the coordinate frame of the task needed(e.g., a robot frame for robot control, a cart frame for system setup,etc.). Additionally or alternatively, transforming object coordinates totask space may include using known optical scanning device to thesupport platform (e.g., a cart) transformations, the surgical robottransformations, and/or the user interface screen transformations, andgenerating new transformations for specific tasks such as tracking thesurgeon's body (e.g., face, hands, etc.) with respect to differentelements of the system (e.g., support platform, robot arms, screen,etc.), tracking the surgical table with respect to the cart platform,tracking patient orientation for system setup, tracking trocar portlocation and orientation for setup, and tracking the position ofoperating room staff for safety. At step 2210, the desired task may beperformed, e.g., moving the robot arms into the vicinity of thepatient/trocar port for easy setup, tracking operating room staff toensure the system only responds to surgeon commands, recording thesurgeon's hand movements during different phases of surgery, etc.

In addition, FIG. 22 illustrates a flow chart of process 2212 for theacquisition and processing of data from an optical scanning device. Atstep 2214, depth data may be acquired from one or more optical scanningdevices, e.g., optical scanner 1100. At step 2216, specular noisefiltering may be performed. At step 2218, patient/trocar portsegmentation and identification may be performed. At step 2218, trackedport coordinates may be transformed to robot coordinate space. At step2222, the robot arms may be moved to a desired vicinity of thepatient/trocar port.

Referring now to FIG. 23, an example data flow 2300 of the system isprovided. As shown in FIG. 23, non-real-time computer 2302 may gatherdata from an optical scanning device, e.g., optical scanner 1100 and/orfrom a camera feed from a laparoscope. Non-real-time computer 2302 alsomay receive data from real-time computer 2308 having a robot controller,including telemetry information such as positions of the robot arms,forces applied to the various motors/sensors of the robot arms,operational mode information, etc. Non-real-time computer 2302 also mayreceive data from patient database 2310 having information specific tothe patient in the procedure including, e.g., CT scan data, relevanthealth conditions, and other information that may be desired by thesurgeon.

Non-real-time computer 2302 further may provide user feedback 2312 tothe user via user interface 2314. User feedback may include, e.g.,collision notifications, positioning information and/or recommendationsregarding the various components of the system, the operational modethat has been detected by the system, etc. Non-real-time computer 2302further may provide commands 2318, e.g., high level commands, toreal-time computer 2308. High-level commands may include, e.g., modechanges, trajectories, haptic barriers, user configurations, etc.Real-time computer 2308 may include robot controller 2320 programmed toprovide robot commands 2322, e.g., motion or force commands, to the oneor more robot arms 2324, e.g., robot arms 300. Robot controller 2320 mayreceive robot feedback data 2326, e.g., motion, force, and/or touchpointdata, etc., from the one or more robotic arms 2324.

Referring now to FIG. 25, method 2500 for estimating user fatigue duringa surgical procedure using robot arm 300 is provided. As describedabove, the algorithms for gravity compensation, viscosity, and/oreffects of mass may be used to account for user fatigue. Specifically,during a laparoscopic procedure, a surgeon may be subject to fatigue andmay experience hand tremor or erroneous tool motion for surgical toolssuch as, e.g., scissors, needle drivers, cautery tools, graspers, as theprocedure progresses. As shown in FIG. 25, at step 2502, the system mayreceive and monitor data indicative of the operator's performance, e.g.from optical scanner 1100 such as a LiDAR camera, robot telemetry,and/or an endoscope, during the surgical procedure while the operatormaneuvers the surgical instruments coupled to robot arm 300. Learningfrom a large dataset of clinical procedures and/or gathering andanalyzing data during a procedure or a portion of a procedure may allowthe system to infer a level of competency of the surgeon as theprocedure progresses, at step 2504, and further may allow the system toadapt algorithm parameters in order to help the surgeon to move moreeffectively while co-manipulating the surgical instruments attached tothe robot arm. For example, at step 2506, the system may adjust one ormore operating parameters of robot arm 300 to change its behavior. Ifthe fatigue level goes above a specific threshold, at step 2608, thesystem may warn the surgeon. In addition, ranking procedures may be usedto allow the system to provide the surgeon a summary of theirperformance for a given procedure and show their overall progress,procedure after procedure.

In some embodiments, the system may collect data during a procedureindicative of at least one of operator hand tremor, distance/minimumpath travelled by the instrument tip, time to achieve procedure steps,and/or time to complete the procedure, and compare such data withthreshold or predefined values for each of the factors to determinewhether a magnitude of any one of the factors has reached a levelsufficient to cause the system to warn the operator and/or sufficient tocause the system to adjust one or more operating parameters to mitigatethe user's fatigue. For example, the system may eliminate or reducetremor of the instrument tip by exerting forces on the instrument toincrease the impedance or viscosity of the instrument, to avoid criticalstructures, and/or to apply force feedback. User fatigue may beidentified when, for example, a procedure time increases beyond athreshold value for a particular procedure, the number of movements ofthe surgical instrument increases beyond a threshold value for aparticular procedure or otherwise indicates errant or uncontrolledmovements, if an operator moves an instrument into a haptic barrier apredefined number of times, if an operator exerts an excessive force onthe trocar one or a predetermined number of times, etc. As describedabove, such data may be collected using the sensors on the robot armsand/or one or more optical scanning devices. When a particular level ofuser fatigue is identified by the system, the system may increase aviscosity or impedance of the instrument and/or the robot arm associatedwith the instrument to reduce a magnitude of movements and/or a numberof movements of the surgical instrument and/or the robot arm.

Additionally, the system may collect data regarding the speed andfrequency with which the operator moves the variousinstruments/laparoscopes along with estimates of how much tremor isinvolved in the movements, estimate the required added viscosity toreduce tremors while not hindering their motions or adding unnecessaryfatigue to the operator. In some embodiments, a controller of robot arm300 may iteratively adjust a viscosity value for a particularinstrument, collect data related to the movement of the instrument, andto assess whether an additional adjustment is needed to the viscosityapplied to the instrument. Moreover, the system may use additionalalgorithms to adopt an iterative approach to optimizing a particularoperational characteristic or parameter of robot arm 300, includingcollecting data related to a particular operational characteristic orparameter, changing operational characteristic or parameter, collectingadditional data related to the operational characteristic or parameter,and analyzing the data to determine if additional changes to theoperational characteristic or parameter should be made, which may bebased on, e.g., deviations between the actual data values and preferredor optimal values of an operational characteristic or parameter.

Referring now to FIG. 26, dataflow 2600 of a distributed network ofco-manipulation surgical robot systems is provided. For example, adistributed network of co-manipulation robotic (“cobot”) surgicalsystems may be used in multiple hospitals, each of which may beconnected to an online database. This arrangement may provideconsiderably more data and user information that may be used by any ofthe cobot systems in operation. The systems may aggregate the data fromthe distributed network of systems to identify the optimum configurationbased on factors such as procedure type, surgeon experience, patientattributes etc. Through analytics or clinician input, the cobot systemsmay identify a routine procedure versus a procedure that may be morecomplicated. This information may be used to provide advice or guidanceto novice surgeons.

Moreover, centralizing procedure data may enable the running of largedata analytics on a wide range of clinical procedures coming fromdifferent users. Analysis of data may result in optimized settings for aspecific procedure, including, e.g., optimized system positioning,optimal ports placement, optimal algorithms settings for each robot armand/or detection of procedure abnormalities (e.g., excessive force,time, bleeding, etc.). These optimal settings or parameters may dependon patient and tool characteristics. As described above, a surgeon mayload and use optimal settings from another surgeon or group of surgeons.This way, an optimal setup may be achieved depending on, e.g., thesurgeon's level of expertise. To keep track of the various users in thedistributed network of cobot systems, it may be beneficial to identifyeach user. As such, the user may log into the cobot system and accesstheir profile online as necessary. This way the user may have access totheir profile anywhere and will be able to perform a clinical procedurewith their settings at a different hospital location.

An example user profile may contain the user's specific settings andinformation, including, e.g., username; level of expertise; differentprocedures performed, and/or region of clinical practice. In addition,the clinical procedure may require a user to store specific settingssuch as clinical procedure (e.g., cholecystectomy, hernia, etc.), tableorientation and height, preferred port placement, settings per assistantarm for each algorithm, patient characteristics (e.g., BMI, age, sex),and/or surgical tools characteristics and specifications (e.g., weights,length, center of gravity, etc.). The user may be able to enable his ownprofile, and optionally may enable another user's profile, such as theprofile of a peer, the most representative profile of a surgeon of theuser's area of practice, the most representative profile of a surgeonwith a specific level of expertise, and/or the recommended profileaccording to patient characteristics.

The identification of a user may be performed via password, RFID key,facial recognition, etc. Learning from a large number of procedures mayresult in a greater level of optimization of the cobot system setup fora given procedure. This may include, e.g., cart position, individualrobot arm position, surgical table height and orientation, portplacement, and/or setup joints position. These settings may be based onpatient height, weight, and sex, and further may be interdependent. Forexample, the optimal port placement may depend on patient tableorientation.

Additionally, a clinical procedure may be described as a sequence ofclinical procedures steps. Learning these different steps may allow thecobot system to infer in real time the actual step for a givenprocedure. For example learning clinical steps from procedures may allowor enable: adjustment of algorithm settings, the system to give thepractical custom reminders, the system to notify staff of an estimateprocedure end time, the system to alert staff if necessary equipment isnot available in the room, and/or the system to alert staff of theoccurrence of an emergency situation.

During a clinical procedure, the surgeon will often realize simple androutine surgical tasks such as grasping, retracting, cutting etc.Learning these different tasks may allow the cobot system to infer inreal time preferences and habits of the surgeon regarding a sequence ofa procedure in real time. Some algorithms of the cobot system may betuned (i.e., adjusted and optimized) during the procedure based on thissequence recognition and help the user to be better at this simplesurgical task. An example of such a task is the automated retraction ofa liver during a gall bladder procedure. By aggregating the informationover many cases, the optimized force vectors may be developed.

Further, some complications may occur during a clinical procedure thatmay result in unexpected steps or surgical acts. Learning how todiscriminate these unexpected events would help the cobot system toenable some specific safety features. In case of emergency, the robotarms may be stopped or motion restricted depending on the level ofemergency detected by the system.

Referring now to FIGS. 27A to 27D, setup of the co-manipulation surgicalsystem is provided. Platform 2700 may be constructed similar to platform100, such that platform 2700 supports one or more robot arms, e.g.,robot arm 300 a′ and robot arm 300 b′, and may cause the robot arms tomove relative to platform 2700. As shown in FIG. 27A, platform 2700 maybe moved to a desirable position relative to patient table PT by a user,e.g., via wheels 104′, while robot arms 300 a′, 300 b′ are in theirrespective stowed configurations.

As platform 2700 is being moved toward the patient, the scene may bedirectly observed by a depth mapping sensor, e.g., optical scanner1100′, which may be mounted on platform 2700. From the depth mapsobserved and generated by optical scanner 1100′, key features may beidentified such as, for example, the height and/or location of patienttable PT, the surface of the patient's abdomen, position and othercharacteristics of the surgeon, including the surgeon's height, and thetrocar port(s), the base of robot arms 300 a′, 300 b′, e.g., baseportions 302 a′, 302 b′ and shoulder portions 304 a′, 304 b′, robot arms300 a′, 300 b′, and/or one or more surgical instruments coupled with therobot arms. Identification of such key features may be carried out usingstandard computer vision techniques such as template matching, featuretracking, edge detection, etc. As each feature is registered, itsposition and orientation may be assigned a local co-ordinate system andtransformed into the global co-ordinate system the system using standardtransformation matrices. Once all features are transformed into a singleglobal co-ordinate system, an optimization algorithm, e.g., leastsquares and gradient descent, may be used to identify the mostappropriate vertical and horizontal positions of robot arms 300 a′, 300b′, which may be adjusted via platform 2700, to maximize the workspaceof the robot arms with respect to the insertion point on the patient.The optimal workspace may be dependent on the surgical operation to beperformed and/or the surgeon's preferred position.

As shown in FIG. 27B, when platform 2700 is in its desired positionrelative to patient table PT, such that wheels 104′ are locked, robotarms 300 a′, 300 b′ may be extended away from their respective stowedconfigurations. As shown in FIG. 27C, the vertical position of the robotarms relative to platform 2700 may be adjusted to the desired position,and as shown in FIG. 27D, the horizontal position of the robot armsrelative to platform 2700 may be adjusted to the desired position.

Referring now to FIGS. 28A to 28D, screenshots of exemplary graphicaluser interface 2800 are provided. Exemplary graphical user interface2800 may be configurable by a user and may be integrated with display110. FIG. 28A illustrates an exemplary start menu. The operator mayinitiate operation of the co-manipulation system by actuating the“start” option. FIG. 28B illustrates an exemplary system setup screen.As shown in FIG. 28B, when the system includes two robot arms, graphicaluser interface 2800 may identify which robot arm is to be used withwhich instrument, e.g., retractor arm 2806 and endoscope arm 2808, aswell as the procedure to be completed. Graphical user interface 2800 maypermit the user to pre-load specific calibration files or setup jointpositions based on the procedure being performed and/or the surgeonperforming the procedure. For example, if the user inputs that aprocedure is a laparoscopic cholecystectomy, the system may pre-loadtool types known to be associated with that procedure. Populating thesepre-loaded settings may be achieved by monitoring which tools a usermanually selects for a given procedure. If a given tool is consistentlyselected for a predetermined number of procedures, the system mayautomatically pre-populate that tool the next time the procedure isselected by the user.

In addition, the operator may adjust the vertical and horizontalposition of each robot arm, as shown in FIGS. 27C and 27D above. Asshown in FIG. 28B, to adjust the vertical and/or horizontal position ofthe robot arm that will be or is currently coupled to the retractordevice, the operator may toggle adjustment actuator 2802, and to adjustthe vertical and/or horizontal position of the robot arm that will be oris currently coupled to the endoscope device, the operator may toggleadjustment actuator 2804. In some embodiments, the user may adjust thehorizontal and vertical position of the robot arms by using the robotarm as a force sensitive input device. For example, the robot arm may beconfigured to sense the user's intention by measuring the force appliedby the user onto the robot arm. If the user applies a force in thepositive horizontal direction, platform may move the robot arm in thatdirection until the user no longer applies a force. A similar approachbe taken for the other directions, e.g., negative horizontal, positivevertical, and negative vertical. As shown in FIG. 28B, graphical userinterface 2800 may indicate whether an error, e.g., fault condition, isdetected by the system during setup or operation of the system, viaerror notification 2810.

As shown in FIG. 28C, graphical user interface 2800 may displayinformation associated with the selected surgical instruments, asdescribed above. For example, graphical user interface 2800 may display,for each instrument to be coupled to each robot arm, the instrumenttype, overall length, distance between the coupler body and theinstrument tip, distance between the center of mass to the instrumenttip, mass, and the preset unlocking force required to unlock theinstrument. As shown in FIG. 28C, graphical user interface 2800 maypermit the operator to select between a high or low unlocking force ofthe surgical instrument. In addition, graphical user interface 2800 maypermit the operator to initiate a surgical instrument calibration, e.g.,for a new surgical instrument that does not already have an associatedcalibration file stored in the system. FIG. 28D illustrates an exemplaryscreen during operation of the system, e.g. during a surgical procedure.As shown in FIG. 28D, graphical user interface 2800 may display thetrocar force and the force being applied to the tip of the surgicalinstrument, e.g., by tissue within the patient's body.

Referring now to FIG. 29, an alternative co-manipulation surgical robotsystem is provided. System 2900 may be constructed similar to system 200of FIG. 2. For example, platform 1400′, base portion 302′, shoulderportion 304′, encoders E1′, E2′, E3′, E5′, E6′, E7′, motor M1′, shoulderjoint 318′, shoulder link 305′, elbow joint 322′, elbow link 310′, wristportion 311′, and coupler interface 400′ for coupling surgicalinstrument SI to the robot arm, may be constructed similar to platform1400, base portion 302, shoulder portion 304, encoders E1, E2, E3, E5,E6, E7, motor M1, shoulder joint 318, shoulder link 305, elbow joint322, elbow link 310, wrist portion 311, and coupler interface 400,respectively. System 2900 differs from system 200 in that system 2900includes motors disposed at the joints of the robot arm. For example,system 2900 may include motor M2′ disposed at elbow joint 318′ and motorM3′ disposed at elbow joint 322′, configured to rotate the associatedlinks to manipulate the robot arm. In addition, encoder E4′ may bepositioned on or adjacent to elbow join 322′.

Some implementations of the systems described herein may be configuredto be controlled or manipulated remotely, e.g., via joystick or othersuitable remote control device, computer vision algorithm, forcemeasuring algorithm, and/or by other means. However, in a preferredembodiment, the systems described herein operate without any telemetry,e.g., the robot arm is not teleoperated via a remote surgeon consoleseparate from the robot arm, but instead the robot arm moves in responseto movement applied to the surgical instrument coupled thereto. Anyrobot-assisted movements applied to the surgical instrument by thesystem, e.g., in the robotic assist mode, are not responsive to userinput received at a remote surgeon console.

FIG. 30A illustrates a top view of coupler 3000 for coupling surgicalinstrument SI to the robot arm, showing coupler body 3002 (also referredto herein as a body) coupled with coupler interface 3001 (also referredto herein as an interface). FIG. 2B illustrates a top view of coupler3000 of FIG. 30A, showing coupler body 3002 decoupled from couplerinterface 3001. As shown in FIGS. 30A and 30B, coupler 3000 may havecoupler body 3002 and coupler interface 3001. Coupler interface 3001 maybe coupled with robotic arm 300 and may be configured such that couplerbody 3002 may be removably coupled with coupler interface 3001. Couplerbody 150 may be coupled with surgical instrument SI at any desired axialposition on surgical instrument SI. Once coupler body 3002 is coupledwith surgical instrument SI, coupler body 3002 and surgical instrumentSI that is coupled with coupler body 3002 may be coupled with couplerinterface 3001. Coupler body 3002 may be configured such that, oncecoupler body 3002 is coupled with surgical instrument SI, surgicalinstrument SI may be at least inhibited (e.g., prevented) from movingaxially or, in some embodiments, moving axially and rotationallyrelative to coupler body 3002. Coupler 3000 may be configured such thatcoupler body 3002 may be at least inhibited (e.g., prevented) frommoving in any axial direction relative to coupler interface 3001. Insome embodiments, coupler 3000 may be configured such that coupler body3002 is free to rotate relative to coupler interface 3001. In thisconfiguration, surgical instrument SI coupled with coupler body 3002 maybe free to rotate relative to coupler interface 3001 that coupler body3002 is coupled with, and may be at least inhibited from (e.g.,prevented from) any axial movement relative to coupler interface 3001that coupler body 3002 is coupled with.

In other embodiments, coupler 300 may be configured such that surgicalinstrument SI may be moved in an axial direction relative to couplerbody 3002 upon the application of at least a threshold force on surgicalinstrument SI relative to coupler body 3002 or upon actuation of arelease or a state change of coupler body 3002. Such actuation may beachieved in some embodiments by, e.g., pressing a button, loosening alocking screw or other connector, moving a dial, or otherwise changingcoupler 3000, coupler body 3002, and/or coupler interface 3001 from asecond, secured state to a first, unsecured state. For example, in someembodiments, surgical instrument SI may be axially repositioned relativeto coupler 3000 by loosening one or more thumbscrews 3010 or otherhand-operated fastener or fastening mechanism such as a clamp in couplerbody 3002, repositioning surgical instrument SI in the desired axialposition, and re-tightening thumbscrew 3010 or other hand-operatedfastener or fastening mechanism.

As shown in FIG. 30B, coupler interface 3001 may have recess 3003 sizedand shaped to receive coupler body 3002. Recess 3003 may inhibit (e.g.,prevent) an axial movement or, in some embodiments, an axial and arotational movement of coupler body 3002 relative to coupler interface3001 while permitting free rotational movement of coupler body 3002relative to coupler interface 3001. Coupler 3000 may be configured suchthat surgical instrument SI may be at least inhibited (e.g., prevented)from rotational movement relative to coupler 3000. This may be achievedby at least inhibiting (e.g., preventing) the rotational movementbetween surgical instrument SI and coupler 3000, or between coupler body3002 and coupler interface 3001. In some embodiments, a surgical drapemay be pinched or clamped between coupler body 3002 and couplerinterface 3001.

FIG. 30C illustrates an end view of coupler body 3002 and surgicalinstrument SI, showing coupler body 3002 in the first, unsecured or openstate in which surgical instrument SI may be removed and replaced orrepositioned relative to coupler body 3002. FIG. 30D illustrates an endview of coupler body 3002 of FIG. 30C, showing coupler body 3002 in thesecond, secured or closed state in which surgical instrument SI may beat least inhibited (e.g., prevented) from axial movement or, in someembodiments, axial and rotational movement relative to coupler body3002. In some embodiments, coupler body 3002 may have first portion 3004and second portion 3006. In some embodiments, first portion 3004 may berigidly coupled with second portion 3006 via hinge 3005 or shaft orotherwise. In some embodiments, first and second portions 3004, 3006 mayhave a semicircular cut out or recess 3008 therein sized and shaped toreceive surgical instrument SI therein. Fastener 3010 may be used tocouple first portion 3004 with second portion 3006, such as whensurgical instrument SI is positioned in recesses 3008, as shown in FIG.30D. As described above, coupler body 3002 may be configured to at leastsubstantially inhibit (e.g., prevent) an axial movement or, in someembodiments, an axial and a rotational movement of surgical instrumentSI relative to coupler body 3002. Rubber pads, sheets, bumps, O-rings,projections, or other components or features configured to grip anoutside of surgical instrument SI may be used with any of the couplerembodiments disclosed herein. For example, the rubber interface may bepositioned within the recess or recesses of the coupler body, such asrecesses 3008 of first portion 3004 and/or second portion 3006 ofcoupler body 3002 and may be coupled to coupler body 3002. The rubbermay be a silicone rubber or any other suitable type of rubber.

FIGS. 31A to 31D illustrate another embodiment of coupler 3100 that maybe used with any robotic system embodiments disclosed herein to couplean instrument to an end portion of a robot arm. Coupler 3100 may includecoupler body 3101 and coupler interface 3120 that may have a recess ordepression 3190 configured to receive coupler body 3101 therein. Couplerinterface 3120 may be coupled with an end portion of robot arm 300.Coupler 3100 may have coupler body 3101 that removably or nonremovablycouples directly with an end portion of robot arm 300.

As shown in FIG. 31A, coupler body 3101 may have cylindrical bodyportion 3102 having annular flange 3104 projecting away from the surfaceof cylindrical body portion 3102. Body portion 3102 may have opening3106 extending axially through body portion 3102. Opening 3106 may besized and shaped to receive surgical instrument SI therein. Opening 3106may be slightly larger than a diameter or outside size of surgicalinstrument SI. Coupler body 3101 may have one or more deflectable tabs3108 (two being shown), or four or more deflectable tabs 3108 that maybe configured to deflect radially inwardly so that, when tabs 3108 aredeflected radially inwardly, tabs 3108 exert a force on an outsidesurface of surgical instrument SI. Coupler 3100 may be configured suchthat, when coupler body 3101 is positioned within recess 3109 of couplerinterface 3120 and coupler interface 3120 is in a second, closed orsecured state, coupler interface 3120 may exert a force or otherwisedeflect tabs 3108 radially inward so as to grip surgical instrument SIand at least inhibit (e.g., prevent) an axial movement or axial androtational movement of surgical instrument SI relative to coupler body3101. For example, tabs 3108 may have a greater thickness near distalend 3110 of tabs 3108 such that, in a relaxed state or in the first,open state, distal end 3110 of tabs 3108 may project or protrude awayfrom an outside surface of body portion 3102 of coupler body 3101. Inthis configuration, when coupler body 3101 is positioned within recess3109 of coupler interface 3120, moving coupler interface 3120 to thesecond, closed state may cause a force to be applied to distal endportions 3110 of the tabs 3108 to thereby deflect tabs 3108 inwardlyagainst an outside surface of surgical instrument SI.

In some embodiments, recess 3109 may have enlarged portion 3111 sizedand shaped to receive annular flange 3104 therein and to permit arotational movement of flange 3104, while also restricting or at leastinhibiting (e.g., preventing) an axial movement of coupler body 3101 byproviding an axial limit to the movement of annular flange 3104. In thisarrangement, surgical instrument SI may be axially advanced throughopening 3106 of coupler body 3101 to any desired location. Thereafter,surgical instrument SI with coupler body 3101 coupled thereto may bepositioned within recess 3109 of coupler interface 3120. Couplerinterface 3120 may be removably or non-removably coupled with an endportion of robot arm 300 of any of the co-manipulation surgical systemsdisclosed herein.

As shown in FIG. 31C, rubber pads, sheets, bumps, O-rings, projections,or other gripping features 3112 (O-rings being shown) configured to gripan outside of surgical instrument SI may be positioned within couplerbody 3101 to increase a frictional force between surgical instrument SIand coupler body 3101. In some embodiments, one or more tabs 3108 may beconfigured to exert a force on gripping features 3112 when one or moretabs 3108 are deflected inwardly.

As shown in FIG. 31D, coupler interface 3120 may have first portion 3105that may be coupled with second portion 3103. In some embodiments, firstand second portions 3105, 3103 may be rigid and may be coupled to oneanother via mechanical hinge 3107. Alternatively, a living hinge, ashaft, one or more fasteners, or other components or features may beused to couple first and second portions 3105, 3103 together. In someembodiments, second portion 3103 may be flexible and may be configuredto extend over surgical instrument SI and/or a coupler body 3101supported within recess 3109, such as an elastically elongatable or anelastically rigid strap. Additional fasteners, clamps, clasps, or othercomponents or features may be used in conjunction with or in place ofhinge 3107 to securely couple first and second portions 3105, 3103together once coupler body 3101 is received within recess 3109 ofcoupler interface 3120 to securely couple surgical instrument SI withcoupler 3100.

In some embodiments, the coupler may include a coupler body and acoupler interface having a recess configured to receive the couplerbody. The coupler body may have an opening extending axiallytherethrough configured to receive an instrument and an annular flangeextending around an outside surface thereof. The recess in the couplerinterface may have an enlarged portion configured to receive the annularflange and to permit a rotational movement of the flange while at leastinhibiting (e.g., preventing) an axial movement of the coupler body byproviding an axial limit to the movement of the annular flange. Thecoupler interface may be configured to couple with an end portion of arobotic arm.

FIGS. 32A and 32B illustrate coupler body 3200 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm. Coupler body 3200 may have any of thecomponents, features, and/or other details of any of the otherembodiments of the coupler body disclosed herein, in any combinationwith any of the components, features, and/or other details of theembodiment of coupler body 3200 shown in FIGS. 32A and 32B. Any of theother embodiments of the coupler body disclosed herein may have any ofthe components, features, and/or other details of coupler body 3200, inany combination with any of the components, features, and/or otherdetails of the other coupler body embodiments disclosed herein.

Coupler body 3200 may have opening 3202 axially therethrough sized andshaped to receive a surgical instrument therein and clamping mechanism3204 configured to reduce an inside diameter of opening 3202 as clampingmechanism 3204 is actuated so as to cause coupler body 3200 to move fromthe first, unsecured or open state as shown in FIG. 32A to the second,secured or closed state as shown in FIG. 32B. In this arrangement,coupler body 3200 may be positioned around an outside surface of thesurgical instrument while coupler body 3200 is in the first, open orunsecured state. Thereafter, clamping mechanism 3204 may be actuated soas to cause coupler body 3200 to secure itself to an outside surface ofa surgical instrument. Then, coupler body 3200 may be coupled with acoupler interface sized and configured to receive and support couplerbody 3200.

FIGS. 33A and 33B illustrate coupler body 3300 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm. Coupler body 3300 may have any of thecomponents, features, and/or other details of any of the otherembodiments of the coupler body disclosed herein, in any combinationwith any of the components, features, and/or other details of theembodiment of coupler body 3300. Any of the other embodiments of thecoupler body disclosed herein may have any of the components, features,and/or other details of coupler body 3300, in any combination with anyof the components, features, and/or other details of the other couplerbody embodiments disclosed herein.

Coupler body 3300 may have an opening 3302 axially therethrough sizedand shaped to receive a surgical instrument therethrough and clampingmechanism 3304 having a first and second handle member or tab configuredto reduce an inside diameter of opening 3302 as clamping mechanism 3304is actuated so as to cause coupler body 3300 to move from the first,unsecured or open state as shown in FIG. 33A to the second, secured orclosed state as shown in FIG. 33B. In this arrangement, coupler body3300 may be positioned around an outside surface of the surgicalinstrument while coupler body 3300 is in the first, open or unsecuredstate. Coupler body 3300 may be moved to the first, open or unsecuredstate by squeezing or moving the handles of clamping mechanism 3204together, as shown in FIG. 33A. Thereafter, clamping mechanism 3204 maybe released so as to cause coupler body 3300 to secure itself to anoutside surface of a surgical instrument. Coupler body 3300 may then becoupled with a coupler interface sized and configured to receive andsupport coupler body 3300.

FIGS. 34A to 34C illustrate coupler 3400 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm. Coupler 3400 may have any of thecomponents, features, and/or other details of any of the other couplerembodiments disclosed herein, in any combination with any of thecomponents, features, and/or other details of the embodiment of coupler3400. Any of the other coupler embodiments disclosed herein may have anyof the components, features, and/or other details of coupler 3400, inany combination with any of the components, features, and/or otherdetails of the other coupler embodiments disclosed herein.

Coupler 3400 may have one or more coupler bodies 3402 (two being shown)coupled with coupler interface 3404. Coupler bodies 3402 may be slidablyreceived within openings 3406 in coupler interface 3404. Couplerinterface 3404 may have recess 3408 which may have a semicircularcross-sectional shape or other cross-sectional shape that matches ashape of an outside surface of the surgical instrument extending along alength thereof that may be configured to receive an outside surface ofsurgical instrument SI therein. Coupler bodies 3402 may have a curvedend portion 3410 sized and shaped to route or curve at least partiallyaround an outside surface of surgical instrument SI. In thisconfiguration, coupler bodies 3402 when in a second, secured or closedposition as shown in FIG. 34A, may be used to selectively securesurgical instrument SI in recess 3408 or otherwise secure surgicalinstrument SI to coupler interface 3404. Springs or other biasingmechanisms 3412 may be used to bias coupler bodies 3402 in the second,closed or secured position, as shown in FIG. 34A. The user may pushcoupler bodies 3402 in the axial direction indicated by arrow A1 so asto move coupler bodies 3402 from the second, closed or secured positionto the first, open or unsecured position. The force exerted on couplerbodies 3402 should be greater than the spring or biasing force from thespring or biasing mechanisms 3412 coupled with each of coupler bodies3402.

As shown in FIG. 34B, coupler bodies 3402 may have sloped end surface3414. Sloped end surface 3414 may be configured such that a spacebetween coupler end surface 3414 and an adjacent surface of couplerinterface 3404 is greater at a position of coupler end surface 3414 thatis further away from the recess such that, as surgical instrument SI isadvanced laterally toward recess 3408 in coupler interface 3404, anoutside surface of surgical instrument SI may contact end surface 3414of the coupler body and the slope of end surface 3414 of coupler body3400 will cause coupler body 3400 to move from the second, closed orsecured state toward a first, open or unsecured state to permit surgicalinstrument SI to be received within recess 3408. Coupler body 3400 mayhave a spring or other biasing mechanism 3416 configured to bias couplerbody 3400 to the second, closed or secured state or position.

As shown in FIG. 34C, sloped end surface 3414 of any embodiments ofcoupler bodies 3402 may be sloped such that, as surgical instrument SIis advanced in a downward direction relative to end surface 3418 ofcoupler body 3400, such interaction between an outside surface ofsurgical instrument SI and sloping surface 3418 of coupler body 3402 maycause coupler body 3400 to rotate about pivot point 3420 away fromrecess 3408 and permit surgical instrument SI to be received withinrecess 3408.

FIGS. 35A to 35D illustrate coupler 3500 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm. Coupler 3500 may have any of thecomponents, features, and/or other details of any of the other couplerembodiments disclosed herein, in any combination with any of thecomponents, features, and/or other details of the embodiment of coupler3500. Any of the other coupler embodiments disclosed herein may have anyof the components, features, and/or other details of the coupler 3500,in any combination with any of the components, features, and/or otherdetails of the other coupler embodiments disclosed herein.

Coupler 3500 may have coupler body 3502 that may be coupled with orengaged with coupler interface 3504. For example, coupler body 3502 maybe slidably received within recess 3506 formed in coupler interface3504. Coupler body 3502 also may have recess 3505 that may have asemicircular cross-sectional shape or other cross-sectional shape thatmatches a shape of an outside surface of the surgical instrumentextending along a length of coupler body 3502 that may be configured toreceive and at least partially surround, or in some embodiments fullysurround, an outside surface of surgical instrument SI at least whencoupler 3500 is in the second state, as shown in FIG. 35B.

Coupler body 3502 may be made from a flexible material, such as rubberincluding neoprene. Coupler body 3502 may have a width that is greaterthan a width of the recess and may be biased toward a planar orgenerally planar shape, as shown in FIG. 35A. Coupler body 3502 may beflexible enough such that, when coupler body 3502 is forced toward adistal surface 3506 a of recess 3506, coupler body 3502 will bend orfold about a middle portion or other portion adjacent to recess 3505.Once coupler body 3502 is fully advanced into recess 3506 of couplerinterface 3504, coupler 3500 may be configured to bias coupler body 3502to remain within the second, secured position within recess 3506. Inthis configuration, to secure surgical instrument SI in coupler 3500, anoperator can advance surgical instrument SI into recess 3505 of couplerbody 3502, and continue to advance surgical instrument SI and/or couplerbody 3502 toward distal surface 3506 a. Some embodiments of coupler 3500may be configured such that, once coupler body 3502 and surgicalinstrument SI have been advanced into recess 3506 of coupler interface3504, surgical instrument SI will be axially and/or rotationally securedto coupler 3500. Thereafter, coupler 3500 may be coupled with an endportion of robot arm 300 such that robot arm 300 may be coupled withsurgical instrument SI. In any embodiments, the recess may have sloped,curved, or otherwise tapered leading edge surfaces 3507 leading into therecess to facilitate the advancement of coupler body 3502 into recess3506 of coupler interface 3504.

As shown in FIG. 35E, surgical drape 800 may be positioned betweensurgical instrument SI and coupler body 3302. In other embodiments,surgical drape 800 may be integrated into coupler body 3052 so thatcoupler body 3502 may form a portion of the surgical drape, as shown inFIG. 35F. Coupler body 3502 may be flexible enough to return to theoriginal shape of coupler body 3502 once coupler body 3502 is removedfrom recess 3506. In any embodiments disclosed herein, the coupler bodyor other components or features of the coupler can be configured toradially restrain the instrument.

As shown in FIG. 35C, coupler 3500 may be configured such that couplerbody 3502 has a projection 3503 configured to extend into recess 3506 ofcoupler interface 3504 even when coupler body 3502 is in the first, openor unsecured state as shown in FIG. 35C. Projection 3503 may help biascoupler body 3502 to remain engaged with recess 3506 of couplerinterface 3504 even when coupler body 3502 is in the first, open orunsecured state. As shown in FIG. 35D, coupler body 3502 also may haveprotrusions, flanges, handles, tabs, or other projections 3509 at aproximal end portion thereof configured to facilitate gripping andremoval of coupler body 3502 from recess 3506.

In some embodiments, the coupler may include a coupler body made from aflexible material and a coupler interface having a recess configured toreceive the coupler body. The coupler body may have a recess having acurved profile along a length of a first main surface thereof that isconfigured to receive an instrument therein. The coupler body may beflexible enough such that, when the coupler body is forced toward adistal surface of the recess, the coupler body will fold about a portionthereof adjacent to the recess, thereby at least axially and radiallyrestraining the instrument. The coupler body may be flexible enough toreturn to the original shape of coupler body 3502 once the coupler bodyis removed from the recess.

FIG. 36 illustrates coupler 3600 that may be used with any roboticsystem embodiments disclosed herein to couple an instrument to an endportion of a robot arm. Coupler 3600 may have any of the components,features, and/or other details of any of the other coupler embodimentsdisclosed herein, in any combination with any of the components,features, and/or other details of the embodiment of coupler 3600. Any ofthe other coupler embodiments disclosed herein may have any of thecomponents, features, and/or other details of coupler 3600, in anycombination with any of the components, features, and/or other detailsof the other coupler embodiments disclosed herein.

Coupler 3600 may have a coupler body 3602 that may be coupled with orengaged with coupler interface 3604. For example, coupler body 3602 maybe received within recess 3606 formed in coupler interface 3604. Couplerbody 3602 also may have recess 3615 that may have a semicircularcross-sectional shape or other cross-sectional shape that matches ashape of an outside surface of the surgical instrument extending along alength of coupler body 3602 that may be configured to receive and atleast partially surround, or in some embodiments fully surround, anoutside surface of surgical instrument SI at least when coupler 3600 isin the second state.

Coupler body 3202 may be made from a flexible material, such as rubberincluding neoprene. Other embodiments of coupler body 3202 may be madefrom multiple materials, including first layer 3608 made from a flexiblematerial that may have increased gripping such as a rubber and secondlayer 3610 that may be a backing layer or support layer for first layer3608 may be made from a more rigid material, such as plastic, metal, orotherwise. Recess 3615 may be formed in first layer 3608. Recess 3615may be formed in a middle portion of first layer 3608. Some embodimentsof second layer 3610 may have hinge 3612 in or attached to a middleportion thereof. In some embodiments, hinge 3612 may run generallyparallel to recess 3615 formed in first layer 3608 and recess 3606formed in coupler interface 3604. In some embodiments, coupler body 3602may fold or hinge between the first, open state and the second, closedor secured state about surgical instrument SI by folding or hingingabout hinge 3612.

Coupler body 3600 may have a width that is greater than a width ofrecess 3606. Coupler body 3602 may be configured such that, when couplerbody 3602 is forced toward distal surface 3606 a of recess 3606, couplerbody 3602 will bend or fold about hinge 3612 so as to collapse or closeabout surgical instrument SI positioned within recess 3615 of couplerbody 3602 so as to secure surgical instrument SI within coupler body3602 and coupler interface 3604.

Some embodiments of coupler interface 3604 may have one or more rollers3614 (two being shown) at proximal end 3606 b of the recess 3606 formedin coupler interface 3604. The one or more rollers 3614 may facilitatethe movement of coupler body 3602 into recess 3606 by permitting couplerbody 3602 to roll on the rollers as coupler body 3602 is advanced intorecess 3606. Some embodiments of coupler interface 3604 may haveadditional rollers 3616 along the side wall surfaces 3606 c of recess3606 to continue to facilitate the advancement of coupler body 3602 intorecess 3606. In some embodiments, recess 3606 may have a generallyrectangular shape. In other embodiments, recess 3606 may have a taperedor narrowing profile.

Once coupler body 3602 is fully advanced into recess 3606 of couplerinterface 3604, some embodiments of coupler 3600 may be configured tobias coupler body 3602 to remain within the second, secured positionwithin recess 3606. In this configuration, to secure surgical instrumentSI in coupler 3600, an operator may advance surgical instrument SI intorecess 3615 of coupler body 3602, and continue to advance surgicalinstrument SI and/or coupler body 3602 toward distal surface 3606 a ofrecess 3606. Some embodiments of coupler 3600 may be configured suchthat, once coupler body 3602 and surgical instrument SI have beenadvanced into recess 3606 of coupler interface 3604, surgical instrumentSI will be axially and/or rotationally secured to coupler 3600.Thereafter, coupler 3600 may be coupled with an end portion of robot arm300 such that robot arm 300 may be coupled with surgical instrument SI.

FIG. 37 illustrates coupler 3700 that may be used with any roboticsystem embodiments disclosed herein to couple an instrument to an endportion of a robot arm. Coupler 3700 may have any of the components,features, and/or other details of any of the other coupler embodimentsdisclosed herein, in any combination with any of the components,features, and/or other details of the embodiment of coupler 3700. Any ofthe other coupler embodiments disclosed herein may have any of thecomponents, features, and/or other details of coupler 3700, in anycombination with any of the components, features, and/or other detailsof the other coupler embodiments disclosed herein.

Coupler 3700 may have coupler body 3702 that may be coupled with orengaged with coupler interface 3704. Coupler body 3702 may be receivedwithin recess 3796 formed in coupler interface 3704. Coupler body 3702also may have recess 3705 that may have a semicircular cross-sectionalshape or other cross-sectional shape that matches a shape of an outsidesurface of the surgical instrument extending along a length of couplerbody 3702 that may be configured to receive and at least partiallysurround, or in some embodiments fully surround, an outside surface ofsurgical instrument SI at least when coupler 3704 is in the secondstate, as shown in FIG. 37.

Coupler body 3702 may be made from multiple materials, including firstlayer 3710 made from a flexible material that may have increasedgripping such as a rubber and second layer 3712 that may be a backinglayer or support layer for first layer 3710 may be made from a morerigid material, such as plastic, metal, or otherwise. Recess 3705 may beformed in first layer 3710. In some embodiments, recess 3705 may beformed in a middle portion of first layer 3710. Some embodiments ofsecond layer 3712 may have hinge 3714 in or attached to a middle portionthereof. In some embodiments, hinge 3714 may run generally parallel torecess 3705 formed in first layer 3710 and recess 3706 formed in couplerinterface 3704. In some embodiments, coupler body 3702 may fold or hingebetween the first, open state and the second, closed or secured stateabout surgical instrument SI by folding or hinging about hinge 3714.

Coupler body 3702 may have a width that is greater than a width ofrecess 3706. Coupler body 3702 may be configured such that, when couplerbody 3702 is forced toward a distal surface 3706 a of the recess 3706,coupler body 3702 will bend or fold about hinge 3714 so as to collapseor close about surgical instrument SI positioned within recess 3705 ofcoupler body 3702 so as to secure surgical instrument SI within couplerbody 3702 and coupler interface 3704. In some embodiments, second layer3712 may have wings or tabs 3716 that may be used to facilitate removalof coupler body 3702 from recess 3706. Tabs 3716 may be formed suchthat, when coupler body 3702 is in the second position, as shown in FIG.37, tabs 3716 may be spaced apart from first surface 3704 a (which canbe an upper surface when coupler interface 3704 is positioned as shownin FIG. 37) such that a gap or space 3720 exists between tabs 3716 andupper surface 3704 a of coupler interface 3704. Space 3720 may be largeenough to permit tabs 3716 to move toward first surface 3704 a when aforce is applied to tabs 3716 in the direction of first surface 3704 a.As tabs 3716 are deflected toward first surface 3704 a, such movement oftabs 3716 may force a remainder of coupler body 3702 to move away from adistal surface 3706 a of recess 3706, thereby allowing coupler body 3704to be removed from recess 3706.

Some embodiments of coupler interface 3704 may have one or more rollers3717 (two being shown) at proximal end 3706 b of recess 3706 formed incoupler interface 3704. The one or more rollers 3717 may facilitate themovement of coupler body 3702 into recess 3706 by permitting couplerbody 3702 to roll on the rollers as coupler body 3702 is advanced intorecess 3706. Some embodiments of coupler interface 3704 may haveadditional rollers 3718 along the side wall surfaces 3706 c of recess4706 to continue to facilitate the advancement of coupler body 3702 intorecess 3706.

Once coupler body 3702 is fully advanced into recess 3706 of couplerinterface 3704, some embodiments of coupler 3700 may be configured tobias coupler body 3702 to remain within the second, secured positionwithin recess 3706. In this configuration, to secure surgical instrumentSI in coupler 3700, an operator may advance surgical instrument SI intorecess 3705 of coupler body 3703, and continue to advance surgicalinstrument SI and/or coupler body 3702 toward distal surface 3706 a ofrecess 3706. Some embodiments of coupler 3700 may be configured suchthat, once coupler body 3702 and surgical instrument SI have beenadvanced into recess 3706 of coupler interface 3704, surgical instrumentSI will be axially and/or rotationally secured to coupler 3700.Thereafter, coupler 3700 may be coupled with an end portion of robot arm300 such that robot arm 300 may be coupled with surgical instrument SI.

FIGS. 38A and 38B illustrate coupler 3800 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm. Coupler 3800 may have any of thecomponents, features, and/or other details of any of the other couplerembodiments disclosed herein, in any combination with any of thecomponents, features, and/or other details of the embodiment of coupler3800. Any of the other coupler embodiments disclosed herein may have anyof the components, features, and/or other details of coupler 3800, inany combination with any of the components, features, and/or otherdetails of the other coupler embodiments disclosed herein.

Coupler 3800 may have coupler body 3802 that may be coupled with orengaged with a coupler interface (not shown) or may be coupled with orengaged with a robot arm without the presence of a coupler interface(e.g., the coupler body of any embodiments disclosed herein can directlyengage or interface with an end portion of robot arm 300). Coupler body3802 may have first portion 3804 and second portion 3806 coupled withfirst portion 3804. In some embodiments, first portion 3804 may behingedly or rotatably coupled with second portion 3806. For example,coupler body 3802 may have a hinge or joint 3810 that may couple firstand second portions 3804, 3806 together.

In some embodiments, first portion 3804 of coupler body 3802 may haveproximal portion 3804 a and distal portion 3804 b that is integrallyformed with or coupled with proximal portion 3804 a. First portion 3804of coupler body 3802 may have recess 3812 and second portion 3806 ofcoupler body 3820 may have recess 3814, each of which can have asemicircular cross-sectional shape or other cross-sectional shape thatmatches a shape of an outside surface of the surgical instrumentextending along a length of coupler body 3802 that may be configured toreceive and at least partially surround, or in some embodiments fullysurround, an outside surface of surgical instrument SI at least whencoupler 3800 is in the second state. The second state of coupler body3802 is shown FIG. 38B. In some embodiments, second portion 3806 may besimilarly situated and may be a mirror copy of first portion 3804, withproximal portion 3806 a and distal portion 3806 b that is integrallyformed with or coupled with the proximal portion 3806 a.

Some embodiments of coupler 3800 may be configured to be bistable inthat the coupler 3800 will be biased toward either the first, open orunsecured state or the second, closed or secured state and is unstablein any position or state except the first and second states. In thefirst state, distal portion 3804 b of first portion 3804 of coupler 3800is in contact with the distal portion 3806 b of second portion 3806 ofcoupler 3800 and proximal portion 3804 a of first portion 3804 ofcoupler 3800 is rotated away and spaced apart from proximal portion 3806a of second portion 3806 of coupler 3800. In the first, open orunsecured state, surgical instrument SI may be loaded into or removedfrom coupler 3800. In the second state, proximal portion 3804 a of firstportion 3804 of coupler 3800 is in contact with proximal portion 3806 aof second portion 3806 of coupler 3800 and distal portion 3804 b offirst portion 3804 of coupler 3800 is rotated away and spaced apart fromdistal portion 3806 b of second portion 3806 of coupler 3800. In thesecond, closed or secured state, surgical instrument SI loaded intocoupler 3800 may be secured or supported by coupler 3800 such thatsurgical instrument SI may be at least inhibited (e.g., prevented) froman axial movement or, in some embodiments, an axial and a rotationalmovement relative to the coupler 3800.

In this configuration, when coupler 3800 is in the first, open state asshown in 38A, after positioning surgical instrument SI in either recess3812 with recess 3814, the operator may change coupler 3800 to thesecond, closed state by pinching or moving the proximal portion 3804 aof first portion 3804 toward proximal portion 3806 a of second portion3806, such as by exerting a force on proximal portions 3804 a, 3806 a offirst and second portions 3804, 3806 along the directions A3 and A4, asshown in FIG. 38A (e.g., by squeezing the proximal portions 3804 a, 3806a of first and second portions 3804, 3806 together). When coupler 3800is in the second, closed state as shown in FIG. 38B, the operator maychange coupler 3800 to the first, open state by pinching or movingdistal portion 3804 b of first portion 3804 toward distal portion 3806 bof second portion 3806, such as by exerting a force on distal portions3804 b, 3806 b of first and second portions 3804, 3806 along thedirections A5 and A6, as shown in FIG. 38B (e.g., by squeezing distalportions 3804 b, 3806 b of first and second portions 3804, 3806together).

FIGS. 39A and 39B illustrate coupler 3900 that may be used with anyrobotic system embodiments disclosed herein to couple an instrument toan end portion of a robot arm.

Coupler 3900 may have any of the components, features, and/or otherdetails of any of the other coupler embodiments disclosed herein, in anycombination with any of the components, features, and/or other detailsof the embodiment of coupler 3900. Any of the other coupler embodimentsdisclosed herein may have any of the components, features, and/or otherdetails of the coupler 3900, in any combination with any of thecomponents, features, and/or other details of the other couplerembodiments disclosed herein.

Coupler 3900 may have a coupler body 3902 that may be coupled with orengaged with a coupler interface (not shown) or may be coupled with orengaged with a robotic arm without the presence of a coupler interface.Coupler body 3902 may have one or more projections 3903 (two beingshown) that may be used to center or position coupler body 3902 relativeto the coupler interface. For example, projections 3903 may be conicalprojections configured to engage with depressions or openings in thecoupler interface to align coupler body 3902 with the coupler interface.In some embodiments, the coupler interface may have an equal number or adifferent number of depressions or openings as compared to the number ofprojections 3903. In other embodiments, projections 3903 may becylindrically shaped. In some embodiments, coupler body 3902 may havethree or more projections 3903.

Coupler body 3902 may have first tab 3904 hingedly or rotatably coupledwith coupler body 3902 and second tab 3906 hingedly or rotatably coupledwith coupler body 3902. For example, coupler body 3902 may have a firsthinge or joint 3910 that may couple first tab 3904 with coupler body3902 and a second hinge or joint 3911 that may couple second tab 3906with coupler body 3902. First tab 3904 may have proximal end portion3904 a and distal end portion 3904 b, as shown in FIG. 39B. Second tab3906 may have proximal end portion 4906 a and distal end portion 4906 b.

Coupler body 3902 may have recess 3914 formed therein, first tab 3904may have recess 3916 formed in a distal end portion thereof and secondtab 3906 may have recess 3918 formed in a distal end portion thereof,each of which may have a semicircular cross-sectional shape or othercross-sectional shape that, all together, may match a shape of anoutside surface of surgical instrument SI extending along a length ofcoupler body 3902, first tab 3904, and second tab 3906 and that may beconfigured to receive and at least partially surround, or in someembodiments fully surround, an outside surface of surgical instrument SIat least when coupler 3900 is in the second state. The second state ofcoupler body 3902 is shown in FIG. 39B. In some embodiments, second tab3906 may be similarly situated and may be a mirror copy of first tab3904.

Some embodiments of coupler 3900 may be biased toward the second state,using springs or other torsional biasing elements. An operator mayovercome the bias or otherwise move coupler body 3902 from the secondstate as shown in FIG. 39B to the first state as shown in FIG. 39A bysqueezing together or toward one another proximal end portions 3904 a,3906 a of first and second tabs 3904, 3906. In the first state, theoperator may remove surgical instrument SI from coupler 3900. To supporta surgical instrument SI in coupler 3900, while coupler 3900 is in thefirst, open state, the operator may position surgical instrument SI incontact with or near recess 3914 and release the force that was appliedto first and second tab 3904, 3906 or otherwise relax first and secondtab 3904, 3906 and allow first and second tabs 3904, 3906 to return tothe relaxed position of first and second tabs 3904, 3906.

FIGS. 40 to 43 illustrate additional couplers 4000, 4100, 4200, 4300.Couplers 4000, 4100, 4200, 4300 may have any of the components,features, and/or other details of any of the other coupler embodimentsdisclosed herein, in any combination with any of the components,features, and/or other details of the embodiment of couplers 4000, 4100,4200, 4300. Any of the other coupler embodiments disclosed herein mayhave any of the components, features, and/or other details of couplers4000, 4100, 4200, 4300 in any combination with any of the components,features, and/or other details of the other coupler embodimentsdisclosed herein.

As shown in FIG. 40, coupler 4000 may have first body portion 4002 andsecond body portion 4004 that may be slidably coupled with or engagedwith first body portion 4002. Coupler 4000 may have a recess or opening4006 that may be enlarged and may be configured to receive surgicalinstrument SI therein when second body portion 4004 is moved towardfirst body portion 4002. A spring or other biasing mechanism 4008 may beused to bias coupler 4000 toward the second, closed or secured state sothat, when an operator releases first and second body portions 4002,4004, coupler 4000 may exert a force on a surgical instrument to securethe surgical instrument therein. Some embodiments of coupler 400 may befigured to axially restrain a surgical instrument therein, but to permita rotation of the surgical instrument. Coupler 4000 may be coupled witha coupler interface or directly to an end portion of robot arm 300.

As shown in FIG. 41, coupler 4100 may have first body portion 4102 andsecond body portion 4104 that may be slidably coupled with or engagedwith first body portion 4102. Coupler 4100 may have a recess or opening4106 that may be enlarged and may be configured to receive surgicalinstrument SI therein when second body portion 4104 is moved towardfirst body portion 4102. Spring 4108 or other biasing mechanism may beused to bias coupler 4100 toward the second, closed or secured state sothat, when an operator releases first and second body portions 4102,4104, coupler 4100 may exert a force on a surgical instrument to securethe surgical instrument therein. Some embodiments of coupler 4100 may befigured to axially restrain a surgical instrument therein, but to permita rotation of the surgical instrument. Coupler 4100 may be coupled witha coupler interface or directly to an end portion of robot arm 300.

As shown in FIG. 42, coupler 4200 may have first body portion 4202having proximal end portion 4202 a and distal end portion 4202 b andsecond body portion 4204 having proximal end portion 4204 a and distalend portion 4204 b that may be rotatably coupled with or engaged withfirst body portion 4202 about an axis or shaft 4207. Coupler 4200 mayhave a recess or opening 4206 formed in distal end portions 4202 b, 4204b that may be enlarged and may be configured to receive surgicalinstrument SI therein when distal end portion 4204 b of second bodyportion 4204 is rotated away from distal end portion 4202 b of firstbody portion 4202. Spring 4208 or other biasing mechanism may be used tobias coupler 4200 toward the second, closed or secured state so that,when an operator releases first and second body portions 4202, 4204,coupler 4200 may exert a force on a surgical instrument to secure thesurgical instrument therein. Some embodiments of coupler 4200 may befigured to axially restrain a surgical instrument therein, but to permita rotation of the surgical instrument. Coupler 4200 may be coupled witha coupler interface or directly to an end portion of robot arm 300.

As shown in FIG. 43, coupler 4300 may be configured to engage with acoupler interface or the distal end portion 4301 of a robot arm. Coupler4300 may be constructed similar to coupler 4200, with similar componentshaving like-prime reference numerals. Coupler 4300 differs from coupler4200 in that coupler 4300 may have projections 4302 extending inwardlyfrom an inner surface of proximal end portion 4202 a′ of first bodyportion 4202′ and an inner surface of proximal end portion 4204 a′ ofsecond body portion 4204′ that may be received within recesses 4304formed in distal end portion 4301 of the robot arm when coupler 4300 isin the second, closed state.

While various illustrative embodiments of the invention are describedabove, it will be apparent to one skilled in the art that variouschanges and modifications may be made therein without departing from theinvention. The appended claims are intended to cover all such changesand modifications that fall within the true scope of the invention.

What is claimed:
 1. A co-manipulation surgical system to assist withlaparoscopic surgery performed using a surgical instrument having ahandle, an operating end, and an elongated shaft therebetween, theco-manipulation surgical system comprising: a robot arm comprising aproximal end, a distal end configured to be removably coupled to thesurgical instrument, a plurality of links, and a plurality of joints;and a controller operatively coupled to the robot arm, the controllerprogrammed to cause the robot arm to automatically switch between: apassive mode responsive to determining that movement of the robot armdue to movement at the handle of the surgical instrument is less than apredetermined amount for at least a predetermined dwell time period, thecontroller configured to cause the robot arm to maintain a staticposition in the passive mode; and a co-manipulation mode responsive todetermining that force applied at the robot arm due to force applied atthe handle of the surgical instrument exceeds a predetermined threshold,the controller configured to permit the robot arm to be freely moveablein the co-manipulation mode responsive to movement at the handle of thesurgical instrument for performing laparoscopic surgery using thesurgical instrument, the controller configured to apply a firstimpedance to the robot arm in the co-manipulation mode to account forweight of the surgical instrument and the robot arm.
 2. Theco-manipulation surgical system of claim 1, wherein the controller isprogrammed to cause the robot arm to automatically switch to a hapticmode responsive to determining that at least a portion of the robot armis outside a predefined haptic barrier, the controller configured toapply a second impedance to the robot arm in the haptic mode greaterthan the first impedance, thereby making movement of the robot armresponsive to movement at the handle of the surgical instrument moreviscous in the haptic mode than in the co-manipulation mode.
 3. Theco-manipulation surgical system of claim 2, wherein the predefinedhaptic barrier is configured to guide the surgical instrument coupled tothe distal end of the robot arm to assist with the laparoscopic surgery.4. The co-manipulation surgical system of claim 3, wherein thepredefined haptic barrier comprises a haptic funnel configured to guidethe surgical instrument coupled to the distal end of the robot arm intoa trocar.
 5. The co-manipulation surgical system of claim 1, wherein thecontroller is configured to receive information associated with thesurgical instrument coupled to the distal end of the robot arm, theinformation comprising at least one of instrument type, weight, centerof mass, length, or instrument shaft diameter.
 6. The co-manipulationsurgical system of claim 5, further comprising a database comprisinginformation associated with a plurality of surgical instruments, whereinthe controller is configured to access the database to retrieve theinformation associated with the surgical instrument coupled to thedistal end of the robot arm.
 7. The co-manipulation surgical system ofclaim 5, further comprising an optical scanner configured to measuredepth data, wherein the controller is configured to identify thesurgical instrument coupled to the distal end of the robot arm based onthe measured depth data.
 8. The co-manipulation surgical system of claim5, wherein the controller is configured to be calibrated to the surgicalinstrument when the surgical instrument is coupled to the distal end ofthe robot arm.
 9. The co-manipulation surgical system of claim 1,further comprising: a base housing at the proximal end of the robot arm;and motors for controlling the robot arm, wherein all the motors for therobot arm are disposed within the base housing.
 10. The co-manipulationsurgical system of claim 9, wherein the controller is programmed todetect a fault condition of the co-manipulation surgical system, andwherein, if a fault condition is detected, the controller causesactuation of brakes of the motors.
 11. The co-manipulation surgicalsystem of claim 1, wherein the robot arm comprises a base rotatablycoupled to the proximal end of the robot arm, such that the robot arm isconfigured to move relative to the base, the system further comprising:a plurality of motors disposed within the base, the plurality of motorsoperatively coupled to at least some joints of the plurality of joints,wherein the controller is operatively coupled to the plurality of motorsand configured to measure current of the plurality of motors, thecontroller programmed to measure a position of the distal end of therobot arm.
 12. The co-manipulation surgical system of claim 11, whereinthe controller is configured to apply a second impedance to the robotarm to resist movement of the robot arm if movement of the distal end ofthe robot arm is less than the predetermined amount for at least thepredetermined dwell time period.
 13. The co-manipulation surgical systemof claim 1, further comprising: a plurality of encoders disposed on atleast some joints of the plurality of joints, the plurality of encodersconfigured to measure angulation of corresponding links of the pluralityof links at the at least some joints, wherein the controller isprogrammed to determine a position of the distal end of the robot arm in3D space based on the angulation measurements by the plurality ofencoders.
 14. The co-manipulation surgical system of claim 1, furthercomprising one or more indicators disposed on at least one link of theplurality of links of the robot arm, the one or more indicatorsconfigured to illuminate a plurality of colors, each color indicative ofa state of the co-manipulation surgical system.
 15. The co-manipulationsurgical system of claim 14, wherein a first color of the plurality ofcolors indicates that the robot arm is in the passive mode, a secondcolor of the plurality of colors indicates that the robot arm is in theco-manipulation mode, and a third color of the plurality of colorsindicates that the robot arm is in a haptic mode.
 16. Theco-manipulation surgical system of claim 15, wherein a fourth color ofthe plurality of colors indicates a fault condition of theco-manipulation surgical system is detected by the controller.
 17. Theco-manipulation surgical system of claim 16, wherein a fifth color ofthe plurality of colors indicates that no surgical instrument is coupledto the distal end of the robot arm.
 18. The co-manipulation surgicalsystem of claim 1, wherein the controller is configured to apply asecond impedance to the robot arm to account for weight of the robot armwhen no surgical instrument is coupled to the distal end of the robotarm.
 19. The co-manipulation surgical system of claim 1, wherein, in thepassive mode, the controller is configured to apply a second impedanceto the robot arm to account for weight of the surgical instrument, theweight of the robot arm, and a force applied to the distal end of therobot arm due to an external force applied to the surgical instrument tocause the robot arm to maintain the static position.
 20. Theco-manipulation surgical system of claim 1, further comprising agraphical user interface configured to display information associatedwith the surgical instrument coupled to the distal end of the robot arm.21. The co-manipulation surgical system of claim 20, wherein thegraphical user interface is configured to permit a user to adjust atleast one of: the predetermined amount of movement at the handle of thesurgical instrument or the predetermined dwell time period to cause therobot arm to automatically switch to the passive mode, the predeterminedthreshold of force applied at the handle of the surgical instrument tocause the robot arm to automatically switch to the co-manipulation mode,a position of a predefined haptic barrier, an identity of the surgicalinstrument coupled to the distal end of the robot arm, a vertical heightof the robot arm, or a horizontal position of the robot arm.
 22. Theco-manipulation surgical system of claim 1, wherein the distal end ofthe robot arm is configured to be removably coupled to the surgicalinstrument which is a laparoscope, a retractor tool, a grasper tool, ora surgical cutting tool.
 23. The co-manipulation surgical system ofclaim 22, wherein, when the distal end of the robot arm is coupled to alaparoscope, the controller is programmed to optically track at leastone of an end-effector of one or more surgical instruments or targetanatomical structures within a field of view of the laparoscope, and tocause the robot arm to automatically switch to a robotic assist moderesponsive to determining that the end-effector of the one or moresurgical instruments or the target anatomical structures are not withina predefined boundary within the field of view of the laparoscope, thecontroller configured to cause the robot arm to move the laparoscope toadjust the field of view of the laparoscope such that the end-effectorof the one or more surgical instruments or the target anatomicalstructures are within the predefined boundary within the field of viewof the laparoscope.
 24. The co-manipulation surgical system of claim 1,wherein the co-manipulation surgical system is not teleoperated via userinput received at a remote surgeon console.
 25. The co-manipulationsurgical system of claim 1, wherein the co-manipulation surgical systemis configured such that a surgeon performing the laparoscopic surgerydoes not contact any portion of the co-manipulation surgical system tomove the surgical instrument while performing the laparoscopic surgery.26. The co-manipulation surgical system of claim 1, further comprisingan optical scanner configured to measure depth data.
 27. Theco-manipulation surgical system of claim 1, further comprising a secondrobot arm comprising a proximal end, a distal end configured to beremovably coupled to a second surgical instrument having a handle, anoperating end, and an elongated shaft therebetween, a plurality oflinks, and a plurality of joints between the proximal end and the distalend, and wherein the controller is operatively coupled the second robotarm, the controller programmed to cause the second robot arm toautomatically switch between: a passive mode responsive to determiningthat movement of the second robot arm due to movement at the handle ofthe second surgical instrument is less than a predetermined amount forat least a predetermined dwell time period, the controller configured tocause the second robot arm to maintain a static position in the passivemode; and a co-manipulation mode responsive to determining that forceapplied at the second robot arm due to force applied at the handle ofthe second surgical instrument exceeds a predetermined threshold, thecontroller configured to permit the second robot arm to be freelymoveable in the co-manipulation mode responsive to movement at thehandle of the second surgical instrument for performing laparoscopicsurgery using the second surgical instrument, the controller configuredto apply a second impedance to the second robot arm in theco-manipulation mode to account for weight of the second surgicalinstrument and the robot arm.
 28. The co-manipulation surgical system ofclaim 1, wherein the controller is programmed to cause the robot arm toswitch to a robotic assist mode responsive to user input, the controllerconfigured to cause one or more motors operatively coupled to at leastsome joints of the plurality of joints of the robot arm to repositionthe surgical instrument coupled to the distal end of the robot arm inthe robotic assist mode.
 29. The co-manipulation surgical system ofclaim 1, wherein the controller is configured to automatically identifythe surgical instrument coupled to the distal end of the robot arm viaat least one of an RFID transmitter chip, a barcode, a near fieldcommunication device, a Bluetooth transmitter, or a weight of thesurgical instrument.
 30. A method for performing laparoscopic surgeryusing a co-manipulation surgical system and a surgical instrument havinga handle, an operating end, and an elongated shaft therebetween, themethod comprising: coupling the surgical instrument to a distal end of arobot arm; automatically entering into a co-manipulation mode responsiveto determining that force applied at the robot arm due to force appliedat the handle of the surgical instrument exceeds a predeterminedthreshold; permitting the robot arm to be freely moveable in theco-manipulation mode responsive to movement at the handle of thesurgical instrument for performing laparoscopic surgery using thesurgical instrument, wherein a first impedance is applied to the robotarm in the co-manipulation mode to account for weight of the surgicalinstrument and the robot arm; and automatically entering a passive moderesponsive to determining that movement of the robot arm due to movementat the handle of the surgical instrument is less than a predeterminedamount for at least a predetermined dwell time period, wherein, in thepassive mode, the robot arm maintains a static position.